Provider Demographics
NPI:1730713595
Name:PEREZ, ROBERTO (RBT)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 1ST AVE APT 516
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4938
Mailing Address - Country:US
Mailing Address - Phone:786-678-9518
Mailing Address - Fax:
Practice Address - Street 1:150 E 1ST AVE APT 516
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4938
Practice Address - Country:US
Practice Address - Phone:786-678-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20110197106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician