Provider Demographics
NPI:1124793773
Name:PEREZ, ADA MARIA
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:MARIA
Last Name:PEREZ
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 1:8803 MESCALERO ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8538
Mailing Address - Country:US
Mailing Address - Phone:407-600-3495
Mailing Address - Fax:
Practice Address - Street 1:8803 MESCALERO ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8538
Practice Address - Country:US
Practice Address - Phone:407-600-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician