Healthcare Provider Details

I. General information

NPI: 1942850185
Provider Name (Legal Business Name): JULISSA PERDOMO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

11231 MOONSHINE CREEK CIR
ORLANDO FL
32825-7231
US

V. Phone/Fax

Practice location:
  • Phone: 407-369-3133
  • Fax:
Mailing address:
  • Phone: 407-369-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-77788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: