MEDICARE: IRIS D SUBIT 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	106S00000X	Behavior Technician
2	106E00000X	Assistant Behavior Analyst	0-19-10551

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215578620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS D SUBIT PEREZ

Provider Business Mailing Address
First Line	:	3589 HUNT RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3527
Country	:	US
Telephone Number	:	561-932-6934
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 FOREST HILL BLVD STE 3B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6031
Country	:	US
Telephone Number	:	561-506-3665
Fax Number	:	561-444-2458

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

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	12/08/2021

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Directions to “ IRIS D SUBIT PEREZ ” Practice Location

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