MEDICARE: YASSIN MONTEAGUDO 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
1	106S00000X	Behavior Technician	20-111680	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1407488919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASSIN MONTEAGUDO PEREZ

Provider Business Mailing Address
First Line	:	8412 N MISSIONWOOD CIR UNIT 17A
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-2936
Country	:	US
Telephone Number	:	786-212-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	18505 NW 75TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2961
Country	:	US
Telephone Number	:	786-479-0029
Fax Number	:	786-542-5084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	02/12/2020

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