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General NPI Number Information
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NPI Number | 1548027899
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Entity Type | Individual
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Provider Name | EDIEL PEREZ NOGUERA RBT
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Gender | Male
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 11285 SW 211TH ST
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City | MIAMI
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State | FL
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Zip | 33189-2211
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Country | US
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Telephone | 786-633-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 7040 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33155-1697
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Country | US
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Telephone | 305-610-4097
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CBHCM0106402-P
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-323508
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License Number State | FL
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