MEDICARE: OLGA PERERA

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	246Z00000X	Other Specialist/Technologist	RBT-15-05779	FL
2	106S00000X	Behavior Technician	RBT-15-05779	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-15-05779	OTHER	FL	REGISTERED BEHAVIOR TECHNICIAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902253578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA PERERA

Provider Business Mailing Address
First Line	:	1045 W 76TH ST
Second Line	:	APT 174
City	:	HIALEAH
State	:	FL
Zip	:	33014-3990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 W 76TH ST
Second Line	:	APT 174
City	:	HIALEAH
State	:	FL
Zip	:	33014-3990
Country	:	US
Telephone Number	:	786-468-4779
Fax Number	:

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/02/2019

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Directions to “ OLGA PERERA ” Practice Location

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