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NPI Code Detail

MEDICARE: KENNETH ALEXANDER PEREZ

MEDICARE: KENNETH ALEXANDER PEREZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-21-56168FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386072650
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH ALEXANDER PEREZ
Provider Business Mailing Address
First Line : 9015 SW 138TH ST APT H
Second Line :
City : MIAMI
State : FL
Zip : 33176-7171
Country : US
Telephone Number : 786-702-3422
Fax Number :
Provider Business Practice Location Address
First Line : 5400 S UNIVERSITY DR STE 502
Second Line :
City : DAVIE
State : FL
Zip : 33328-5313
Country : US
Telephone Number : 786-702-3422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2013
Last Update Date : 12/07/2021

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Directions to “ KENNETH ALEXANDER PEREZ ” Practice Location

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