Provider Demographics
NPI:1538857461
Name:PEREZ, BRIAN ENRIQUE
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ENRIQUE
Last Name: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 1:19900 NW 37TH AVE LOT D108
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1717
Mailing Address - Country:US
Mailing Address - Phone:786-370-5695
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 421
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6686
Practice Address - Country:US
Practice Address - Phone:305-320-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician