Healthcare Provider Details

I. General information

NPI: 1477270437
Provider Name (Legal Business Name): YUDARSY PEREZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 10TH AVE N
LAKE WORTH BEACH FL
33461-3345
US

IV. Provider business mailing address

2115 10TH AVE N STE 2115
LAKE WORTH BEACH FL
33461-3345
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-2814
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-506-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-128297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: