Provider Demographics
NPI:1548027899
Name:PEREZ NOGUERA, EDIEL (RBT)
Entity type:Individual
Prefix:
First Name:EDIEL
Middle Name:
Last Name:PEREZ NOGUERA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:MR
Other - First Name:EDIEL
Other - Middle Name:
Other - Last Name:PEREZ NOGUERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:7040 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1697
Mailing Address - Country:US
Mailing Address - Phone:305-610-4097
Mailing Address - Fax:
Practice Address - Street 1:11285 SW 211TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2211
Practice Address - Country:US
Practice Address - Phone:786-633-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM0106402-P251B00000X
FLRBT-24-323508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251B00000XAgenciesCase Management