MEDICARE: VIVIAN CHINEA 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	RBT23273983	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	:	1710679865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN CHINEA PEREZ

Provider Business Mailing Address
First Line	:	2011 W HANNA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-6317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12336 WITHERIDGE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5727
Country	:	US
Telephone Number	:	813-445-1084
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	09/10/2024

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Directions to “ VIVIAN CHINEA PEREZ ” Practice Location

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