=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598817280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIAN A PEREZ PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6625 MIAMI LAKES DR E #383
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-819-5500
-----------------------------------------------------
Fax | 305-200-1226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6625 MIAMI LAKES DR E #383
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-819-5500
-----------------------------------------------------
Fax | 305-200-1226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY0004328
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------