MEDICARE: SUSANA PEREZ CBHCM-P

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	251B00000X	Case Management Agency	CBHCM-P102505	FL
2	171M00000X	Case Manager/Care Coordinator	CBHCM-P102505	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P625-780-85-669-0	OTHER	FL	CREDENTIAL NUMBER

General Provider Information

NPI Number	:	1649923962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA PEREZ CBHCM-P

Provider Business Mailing Address
First Line	:	191 NW 97TH AVE APT 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-4116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 NW 97TH AVE APT 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-4116
Country	:	US
Telephone Number	:	786-372-2133
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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Directions to “ SUSANA PEREZ CBHCM-P” Practice Location

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