Provider Demographics
NPI:1538816889
Name:PEREZ ROJAS, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:PEREZ ROJAS
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 1:12150 SW 128TH CT STE 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4648
Mailing Address - Country:US
Mailing Address - Phone:786-732-0607
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4648
Practice Address - Country:US
Practice Address - Phone:786-732-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL02112026106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110272600Medicaid