Healthcare Provider Details

I. General information

NPI: 1396561114
Provider Name (Legal Business Name): BRENDA PEREZ BAEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 SW 134TH ST STE 210
MIAMI FL
33186-4499
US

IV. Provider business mailing address

470 E 48TH ST
HIALEAH FL
33013-1866
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-6500
  • Fax:
Mailing address:
  • Phone: 305-610-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-392685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: