Provider Demographics
NPI:1497572481
Name:PEREZ, XIOMARA M
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:M
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 1:408 S TAMPANIA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4155
Mailing Address - Country:US
Mailing Address - Phone:845-489-4739
Mailing Address - Fax:
Practice Address - Street 1:3825 HENDERSON BLVD STE 605C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5040
Practice Address - Country:US
Practice Address - Phone:813-461-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-376424106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician