Provider Demographics
NPI:1902549587
Name:PEREZ, LUISA MARIA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:MARIA
Last Name:PEREZ
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 1:770 PONCE DE LEON BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2068
Mailing Address - Country:US
Mailing Address - Phone:786-344-8757
Mailing Address - Fax:786-221-4447
Practice Address - Street 1:770 PONCE DE LEON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2068
Practice Address - Country:US
Practice Address - Phone:786-344-8757
Practice Address - Fax:786-221-4447
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-211594106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician