Healthcare Provider Details

I. General information

NPI: 1487410635
Provider Name (Legal Business Name): CATHERINE DE LA CARIDAD BUENO PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 FOREST HILL BLVD STE 102
WEST PALM BEACH FL
33406-6056
US

IV. Provider business mailing address

289 CYPRESS AVE
WEST PALM BEACH FL
33415-2410
US

V. Phone/Fax

Practice location:
  • Phone: 561-284-0625
  • Fax: 561-584-5033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-321956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: