Provider Demographics
NPI:1881415883
Name:SAN EMETERIO PEREZ, INDIANA (RBT-20-143931)
Entity type:Individual
Prefix:
First Name:INDIANA
Middle Name:
Last Name:SAN EMETERIO PEREZ
Suffix:
Gender:F
Credentials:RBT-20-143931
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 N HIMES AVE APT 1506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5777
Mailing Address - Country:US
Mailing Address - Phone:281-653-4877
Mailing Address - Fax:
Practice Address - Street 1:3309 W WATERS AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2766
Practice Address - Country:US
Practice Address - Phone:813-898-0014
Practice Address - Fax:813-898-0015
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-143931106S00000X
FL0-24-15720106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician