MEDICARE: MAYURI PEREZ ACOSTA

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	106E00000X	Assistant Behavior Analyst	0-25-16218	FL

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	:	1730778119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYURI PEREZ ACOSTA

Provider Business Mailing Address
First Line	:	4612 DAIL RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2007
Country	:	US
Telephone Number	:	619-548-9967
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 DAIL RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2007
Country	:	US
Telephone Number	:	619-548-9967
Fax Number	:

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

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	06/22/2025

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Directions to “ MAYURI PEREZ ACOSTA ” Practice Location

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