Healthcare Provider Details

I. General information

NPI: 1215713573
Provider Name (Legal Business Name): CARLOS JAVIER PEREZ CARRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 PIPERS CAY DR
WEST PALM BEACH FL
33415-4011
US

IV. Provider business mailing address

882 PIPERS CAY DR
WEST PALM BEACH FL
33415-4011
US

V. Phone/Fax

Practice location:
  • Phone: 561-706-0390
  • Fax:
Mailing address:
  • Phone: 561-706-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-296064
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16901
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: