Healthcare Provider Details

I. General information

NPI: 1083217871
Provider Name (Legal Business Name): JUAN SEBASTIAN PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15924 SW 92ND AVE
MIAMI FL
33157-1842
US

IV. Provider business mailing address

15292 SW 104TH ST
MIAMI FL
33196-3294
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5824
  • Fax:
Mailing address:
  • Phone: 786-395-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: