Healthcare Provider Details

I. General information

NPI: 1003529694
Provider Name (Legal Business Name): VICTOR ISAAC PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VICTOR PEREZ RUBIO

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20770 W DIXIE HWY
MIAMI FL
33180-1146
US

IV. Provider business mailing address

20770 W DIXIE HWY
MIAMI FL
33180-1146
US

V. Phone/Fax

Practice location:
  • Phone: 305-931-1617
  • Fax: 786-431-2576
Mailing address:
  • Phone: 305-931-1617
  • Fax: 786-431-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: