Provider Demographics
NPI:1841900859
Name:PEREZ, DATIA LISSET
Entity type:Individual
Prefix:MRS
First Name:DATIA
Middle Name:LISSET
Last Name:PEREZ
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 1:5535 JONQUIL LN APT 107
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2693
Mailing Address - Country:US
Mailing Address - Phone:239-297-6010
Mailing Address - Fax:
Practice Address - Street 1:5535 JONQUIL LN APT 107
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2693
Practice Address - Country:US
Practice Address - Phone:239-297-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-245119106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician