Healthcare Provider Details

I. General information

NPI: 1639704851
Provider Name (Legal Business Name): NATHALI RODRIGUEZ PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10834 SW 240TH LN
HOMESTEAD FL
33032-4700
US

IV. Provider business mailing address

10834 SW 240TH LN
HOMESTEAD FL
33032-4700
US

V. Phone/Fax

Practice location:
  • Phone: 786-362-1969
  • Fax:
Mailing address:
  • Phone: 786-362-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: