Provider Demographics
NPI:1194317164
Name:PEREZ-RIVERO, SELIDETH AMARILYS (LM, CMP)
Entity type:Individual
Prefix:
First Name:SELIDETH
Middle Name:AMARILYS
Last Name:PEREZ-RIVERO
Suffix:
Gender:F
Credentials:LM, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4010
Mailing Address - Country:US
Mailing Address - Phone:787-360-9571
Mailing Address - Fax:407-942-2044
Practice Address - Street 1:751 19TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-5310
Practice Address - Country:US
Practice Address - Phone:787-360-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW399176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife