Provider Demographics
NPI:1215468103
Name:PEREZ REYES, HEYDI
Entity type:Individual
Prefix:
First Name:HEYDI
Middle Name:
Last Name:PEREZ REYES
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 1:9960 ESTERO OAKS DR APT 313
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5312
Mailing Address - Country:US
Mailing Address - Phone:305-363-9356
Mailing Address - Fax:
Practice Address - Street 1:2718 LEE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1537
Practice Address - Country:US
Practice Address - Phone:305-363-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLDN275031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst