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General NPI Number Information
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NPI Number | 1083204937
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Entity Type | Individual
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Provider Name | LLILIAM PEREZ FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 8100 NW 155TH ST STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5865
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Country | US
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Telephone | 786-479-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 5610 NW 176TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-3551
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Country | US
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Telephone | 786-663-1280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 20-119873
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License Number State | FL
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