Healthcare Provider Details

I. General information

NPI: 1205447711
Provider Name (Legal Business Name): IRMA E PEREZ CARDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S ORANGE BLOSSOM TRL STE 400
ORLANDO FL
32809-5734
US

IV. Provider business mailing address

2775 W OKEECHOBEE RD LOT 26A
HIALEAH FL
33010-1060
US

V. Phone/Fax

Practice location:
  • Phone: 407-602-7442
  • Fax: 786-631-4483
Mailing address:
  • Phone: 786-718-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-120543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: