Healthcare Provider Details

I. General information

NPI: 1356256259
Provider Name (Legal Business Name): JESSICA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 MONROE ST
MIAMI FL
33176-7658
US

IV. Provider business mailing address

14901 MONROE ST
MIAMI FL
33176-7658
US

V. Phone/Fax

Practice location:
  • Phone: 305-699-3241
  • Fax: 954-686-4629
Mailing address:
  • Phone: 305-699-3241
  • Fax: 954-686-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2837155
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: