Provider Demographics
NPI:1154776490
Name:PEREZ, ABEL
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 SW 106TH AVE STE C103
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7669
Mailing Address - Country:US
Mailing Address - Phone:786-219-8021
Mailing Address - Fax:786-431-4078
Practice Address - Street 1:19001 SW 106TH AVE STE C103
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7669
Practice Address - Country:US
Practice Address - Phone:786-219-8021
Practice Address - Fax:786-431-4078
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FLCBHCMS100032104100000X, 171M00000X
FLRN9412009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator