Healthcare Provider Details

I. General information

NPI: 1689405565
Provider Name (Legal Business Name): JOSUE D PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 SW 4TH ST
CORAL GABLES FL
33134-1222
US

IV. Provider business mailing address

4901 SW 4TH ST
CORAL GABLES FL
33134-1222
US

V. Phone/Fax

Practice location:
  • Phone: 786-622-6606
  • Fax:
Mailing address:
  • Phone: 786-622-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89291
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1-24-354701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: