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NPI Code Detail

MEDICARE: DEISY MEDEROS PERDOMO

MEDICARE: DEISY MEDEROS PERDOMO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-80773FL
2106E00000XAssistant Behavior AnalystBCABA-0-24-15409FL

General Provider Information

NPI Number : 1033672639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEISY MEDEROS PERDOMO
Provider Business Mailing Address
First Line : 9305 N 20TH ST
Second Line :
City : TAMPA
State : FL
Zip : 33612-8623
Country : US
Telephone Number : 786-601-7217
Fax Number :
Provider Business Practice Location Address
First Line : 5051 MEMORIAL HWY UNIT B
Second Line :
City : TAMPA
State : FL
Zip : 33634-7355
Country : US
Telephone Number : 813-290-0779
Fax Number : 305-675-2216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2019
Last Update Date : 03/17/2026

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Directions to “ DEISY MEDEROS PERDOMO ” Practice Location

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