MEDICARE: TANIA H PEREZ GONZALEZ

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
2	101YM0800X	Mental Health Counselor	IMH13325	FL

General Provider Information

NPI Number	:	1912257106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA H PEREZ GONZALEZ

Provider Business Mailing Address
First Line	:	14483 SW 172ND LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-6619
Country	:	US
Telephone Number	:	786-450-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	14483 SW 172ND LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-6619
Country	:	US
Telephone Number	:	786-450-8836
Fax Number	:

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

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	04/26/2021

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Directions to “ TANIA H PEREZ GONZALEZ ” Practice Location

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