Healthcare Provider Details

I. General information

NPI: 1790132710
Provider Name (Legal Business Name): ISLEDY PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10734 NW 88TH AVE
HIALEAH GARDENS FL
33018
US

IV. Provider business mailing address

10734 NW 88TH AVE
HIALEAH GARDENS FL
33018-4612
US

V. Phone/Fax

Practice location:
  • Phone: 305-697-7415
  • Fax:
Mailing address:
  • Phone: 305-697-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-07006
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: