Healthcare Provider Details

I. General information

NPI: 1891213815
Provider Name (Legal Business Name): JONATHAN PEREZ OJEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14503 SW SKYE DR
PORT SAINT LUCIE FL
34987-5868
US

IV. Provider business mailing address

14503 SW SKYE DR
PORT SAINT LUCIE FL
34987-5868
US

V. Phone/Fax

Practice location:
  • Phone: 786-527-0090
  • Fax:
Mailing address:
  • Phone: 772-678-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68976
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: