Provider Demographics
NPI:1902495302
Name:PEREZ ORTEGA, ANAY
Entity Type:Individual
Prefix:
First Name:ANAY
Middle Name:
Last Name:PEREZ ORTEGA
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 1:1458 N LAWNWOOD CIR APT 27B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4976
Mailing Address - Country:US
Mailing Address - Phone:178-631-9819
Mailing Address - Fax:
Practice Address - Street 1:1458 N LAWNWOOD CIR APT 27B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4976
Practice Address - Country:US
Practice Address - Phone:178-631-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician