Provider Demographics
NPI:1811796428
Name:ALVAREZ PEREZ, LEONARDO ANTONIO I
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:ANTONIO
Last Name:ALVAREZ PEREZ
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 NW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5040
Mailing Address - Country:US
Mailing Address - Phone:786-643-1254
Mailing Address - Fax:
Practice Address - Street 1:6611 NW 84TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5040
Practice Address - Country:US
Practice Address - Phone:786-643-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-417459106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician