Provider Demographics
NPI:1669278339
Name:PEREZ, ALEXANDRA M
Entity type:Individual
Prefix:
First Name:ALEXANDRA
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 1:4601 SW 154TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5234
Mailing Address - Country:US
Mailing Address - Phone:786-587-6305
Mailing Address - Fax:
Practice Address - Street 1:3401 NW 82ND AVE STE 105E
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1052
Practice Address - Country:US
Practice Address - Phone:786-614-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-389050106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician