MEDICARE: YAIMA PEREZ LUGO

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	106E00000X	Assistant Behavior Analyst	0-19-10678	FL
2	106S00000X	Behavior Technician		FL
3	103K00000X	Behavior Analyst	1-23-68275	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	:	1841725447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAIMA PEREZ LUGO

Provider Business Mailing Address
First Line	:	18844 SW 319TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-5330
Country	:	US
Telephone Number	:	786-641-1962
Fax Number	:	305-564-6904

Provider Business Practice Location Address
First Line	:	17901 OLD CUTLER RD STE B305
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-6424
Country	:	US
Telephone Number	:	786-641-1962
Fax Number	:	305-564-6904

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

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	12/04/2023

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Directions to “ YAIMA PEREZ LUGO ” Practice Location

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