Healthcare Provider Details

I. General information

NPI: 1275239923
Provider Name (Legal Business Name): LUISA E PEREZ HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 GUN CLUB RD STE 12
WEST PALM BEACH FL
33415-2833
US

IV. Provider business mailing address

108 SAN JUAN DR
PALM SPRINGS FL
33461-2014
US

V. Phone/Fax

Practice location:
  • Phone: 561-260-2716
  • Fax:
Mailing address:
  • Phone: 561-260-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12672
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: