Provider Demographics
NPI:1912652785
Name:PERERA AGUIAR, ERNEST RAMON
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:RAMON
Last Name:PERERA AGUIAR
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 1:8851 SW 142ND AVE APT 15-28
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4020
Mailing Address - Country:US
Mailing Address - Phone:786-419-9603
Mailing Address - Fax:
Practice Address - Street 1:8851 SW 142ND AVE APT 15-28
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4020
Practice Address - Country:US
Practice Address - Phone:786-419-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21181341106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111804700Medicaid