Provider Demographics
NPI:1952928590
Name:CENTENO PEREZ, CIRO ALEJANDRO
Entity Type:Individual
Prefix:
First Name:CIRO
Middle Name:ALEJANDRO
Last Name:CENTENO PEREZ
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 1:17971 NW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6715
Mailing Address - Country:US
Mailing Address - Phone:786-332-8553
Mailing Address - Fax:
Practice Address - Street 1:10675 SW 190TH ST STE 1202
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7712
Practice Address - Country:US
Practice Address - Phone:786-641-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician