Healthcare Provider Details

I. General information

NPI: 1164974952
Provider Name (Legal Business Name): ALEXANDRA CHRISTINA PEREZ BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY 904
POMPANO BEACH FL
33069-5391
US

IV. Provider business mailing address

2240 SW 92ND TER 2404
DAVIE FL
33324-6848
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax:
Mailing address:
  • Phone: 786-423-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-16-7344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: