Provider Demographics
NPI:1841725447
Name:PEREZ LUGO, YAIMA
Entity type:Individual
Prefix:
First Name:YAIMA
Middle Name:
Last Name:PEREZ LUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18844 SW 319TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5330
Mailing Address - Country:US
Mailing Address - Phone:786-641-1962
Mailing Address - Fax:305-564-6904
Practice Address - Street 1:17901 OLD CUTLER RD STE B305
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6424
Practice Address - Country:US
Practice Address - Phone:786-641-1962
Practice Address - Fax:305-564-6904
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-10678106E00000X
FL106S00000X
FL1-23-68275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician