MEDICARE: PATRICIA SAN JUAN 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	24388215	FL

General Provider Information

NPI Number	:	1578364071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA SAN JUAN PEREZ

Provider Business Mailing Address
First Line	:	5308 SW 117TH AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330-4296
Country	:	US
Telephone Number	:	305-992-3744
Fax Number	:

Provider Business Practice Location Address
First Line	:	5308 SW 117TH AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330-4296
Country	:	US
Telephone Number	:	305-992-3744
Fax Number	:

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

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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Directions to “ PATRICIA SAN JUAN PEREZ ” Practice Location

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