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General NPI Number Information
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NPI Number | 1407354103
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Entity Type | Individual
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Provider Name | DAGNE PEREZ PEREZ
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 01/28/2018
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Provider Practice Location Address
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Address Line | 16414 LAKE CHURCH DR FL 33556
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City | ODESSA
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State | FL
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Zip | 33556-2637
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Country | US
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Telephone | 813-580-2859
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Fax |
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Provider Business Mailing Address
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Address Line | 1032 BRIDLEWOOD WAY
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City | BRANDON
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State | FL
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Zip | 33511-6249
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Country | US
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Telephone | 813-580-2859
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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 |
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License Number State | FL
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