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General NPI Number Information
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NPI Number | 1588467294
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Entity Type | Individual
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Provider Name | SUANY MARY CUSTODIO PEREZ
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Gender | Female
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 810 N JOHN YOUNG PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34741-4912
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Country | US
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Telephone | 407-501-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 SAN FELIPE ST SUITE 990
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City | HOUSTON
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State | TX
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Zip | 77063
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Country | US
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Telephone | 866-610-0580
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Fax | 866-611-1558
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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 |
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