Provider Demographics
NPI:1932976057
Name:PEREZ SUAREZ, TALIA A
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:A
Last Name:PEREZ SUAREZ
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 1:8520 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3812
Mailing Address - Country:US
Mailing Address - Phone:786-562-5410
Mailing Address - Fax:
Practice Address - Street 1:8520 NW 21ST CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3812
Practice Address - Country:US
Practice Address - Phone:786-562-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician