MEDICARE: CHANTELL PEREZ

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
1	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1134672876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTELL PEREZ

Provider Business Mailing Address
First Line	:	3551 SW 9 TERR
Second Line	:	APT: 411
City	:	MIAMI
State	:	FL
Zip	:	33135-4360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 SW 9 TERR
Second Line	:	APT: 411
City	:	MIAMI
State	:	FL
Zip	:	33135-4360
Country	:	US
Telephone Number	:	305-951-9482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	07/29/2016

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Directions to “ CHANTELL PEREZ ” Practice Location

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