=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538046156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANIA DEL SOL PEREZ BEHAVIOR TECHNICIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2324 THUNDERBOLT TRL APT 120
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-1570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-514-1452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2324 THUNDERBOLT TRL APT 120
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-1570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-514-1452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | D622392985000
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------