Healthcare Provider Details

I. General information

NPI: 1225486889
Provider Name (Legal Business Name): BARBARA A PEREZ LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12275 NW 99TH AVE
HIALEAH FL
33018-2969
US

IV. Provider business mailing address

12275 NW 99TH AVE
HIALEAH FL
33018-2969
US

V. Phone/Fax

Practice location:
  • Phone: 786-419-8610
  • Fax:
Mailing address:
  • Phone: 786-419-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-16132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: