Provider Demographics
NPI:1952899452
Name:PEREZ GONZALEZ, BLANCA
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:PEREZ GONZALEZ
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 1:11201 SW 55TH ST UNIT 29
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3103
Mailing Address - Country:US
Mailing Address - Phone:786-255-3773
Mailing Address - Fax:
Practice Address - Street 1:11201 SW 55TH ST UNIT 29
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3103
Practice Address - Country:US
Practice Address - Phone:561-358-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL021010300106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician