Healthcare Provider Details

I. General information

NPI: 1851696793
Provider Name (Legal Business Name): MARTHA ISABEL PEREZ BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD STE 400
HOLLYWOOD FL
33021-6918
US

IV. Provider business mailing address

3045 SW 5TH ST
MIAMI FL
33135-2705
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 305-281-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-13-5428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: