MEDICARE: IDANAY VILA 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	253Z00000X	In Home Supportive Care Agency
2	106S00000X	Behavior Technician	RBT-24-342768	FL

General Provider Information

NPI Number	:	1760949960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDANAY VILA PEREZ

Provider Business Mailing Address
First Line	:	6220 PLUNKETT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-1835
Country	:	US
Telephone Number	:	786-362-0596
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 PLUNKETT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-1835
Country	:	US
Telephone Number	:	786-362-0596
Fax Number	:

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

Provider Enumeration Date	:	02/23/2019
Last Update Date	:	03/12/2026

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Directions to “ IDANAY VILA PEREZ ” Practice Location

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