Provider Demographics
NPI:1194599407
Name:PEREZ BUERGO, EVA LAURA SR
Entity type:Individual
Prefix:MISS
First Name:EVA
Middle Name:LAURA
Last Name:PEREZ BUERGO
Suffix:SR
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 1:3951 NW 65TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6917
Mailing Address - Country:US
Mailing Address - Phone:786-387-0549
Mailing Address - Fax:
Practice Address - Street 1:6506 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2152
Practice Address - Country:US
Practice Address - Phone:239-379-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician