MEDICARE: YUDISLEIDI PEREZ GUITIAN

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

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	:	1497316293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUDISLEIDI PEREZ GUITIAN

Provider Business Mailing Address
First Line	:	11220 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4419
Country	:	US
Telephone Number	:	305-298-7796
Fax Number	:	783-842-3815

Provider Business Practice Location Address
First Line	:	11220 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4419
Country	:	US
Telephone Number	:	305-298-7796
Fax Number	:	783-842-3815

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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