MEDICARE: MISELBY PEREZ COLON

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

General Provider Information

NPI Number	:	1851896369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISELBY PEREZ COLON

Provider Business Mailing Address
First Line	:	3411 SW 116TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3333
Country	:	US
Telephone Number	:	786-287-9052
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 SW 116TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3333
Country	:	US
Telephone Number	:	786-287-9052
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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Directions to “ MISELBY PEREZ COLON ” Practice Location

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