Provider Demographics
NPI:1063751154
Name:PEREZ PINILLO, ANNIA ROSA
Entity type:Individual
Prefix:
First Name:ANNIA
Middle Name:ROSA
Last Name:PEREZ PINILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 NW 173RD DR APT 2204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5512
Mailing Address - Country:US
Mailing Address - Phone:786-486-9749
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 154TH ST STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5861
Practice Address - Country:US
Practice Address - Phone:786-477-5783
Practice Address - Fax:305-512-8805
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist