=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841725447
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAIMA PEREZ LUGO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2017
-----------------------------------------------------
Last Update Date | 12/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17901 OLD CUTLER RD STE B305
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-6424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-641-1962
-----------------------------------------------------
Fax | 305-564-6904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18844 SW 319TH ST
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-641-1962
-----------------------------------------------------
Fax | 305-564-6904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number | 0-19-10678
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-23-68275
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------