MEDICARE: NATHALY FERNANDEZ 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

General Provider Information

NPI Number	:	1588410682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALY FERNANDEZ PEREZ

Provider Business Mailing Address
First Line	:	4910 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2928
Country	:	US
Telephone Number	:	786-334-7948
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2928
Country	:	US
Telephone Number	:	786-334-7948
Fax Number	:

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

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/29/2024

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Directions to “ NATHALY FERNANDEZ PEREZ ” Practice Location

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