MEDICARE: MR. DOUGLAS PEREZ BCBA

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

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295124360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS PEREZ BCBA

Provider Business Mailing Address
First Line	:	321 TO TO LO CHEE DR
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5239
Country	:	US
Telephone Number	:	305-773-4037
Fax Number	:	305-901-1797

Provider Business Practice Location Address
First Line	:	321 TO TO LO CHEE DR
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5239
Country	:	US
Telephone Number	:	305-773-4037
Fax Number	:	305-901-1797

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	11/13/2018

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