Healthcare Provider Details

I. General information

NPI: 1972010486
Provider Name (Legal Business Name): YARISAY PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11224 SW 165TH TER
MIAMI FL
33157-2726
US

IV. Provider business mailing address

11224 SW 165TH TER
MIAMI FL
33157-2726
US

V. Phone/Fax

Practice location:
  • Phone: 786-307-2156
  • Fax:
Mailing address:
  • Phone: 786-307-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-63961
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: