Provider Demographics
NPI:1801662705
Name:PEREZ GARCIA, JOSE MIGUEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:PEREZ GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 SW 114TH AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3355
Mailing Address - Country:US
Mailing Address - Phone:305-720-8347
Mailing Address - Fax:
Practice Address - Street 1:3620 SW 114TH AVE APT 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3355
Practice Address - Country:US
Practice Address - Phone:305-720-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23312027106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician