Provider Demographics
NPI:1215766803
Name:PEREZ RECIO, RAMON
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:PEREZ RECIO
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 1:7637 BRISTOL BAY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7766
Mailing Address - Country:US
Mailing Address - Phone:806-922-7011
Mailing Address - Fax:
Practice Address - Street 1:7637 BRISTOL BAY LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7766
Practice Address - Country:US
Practice Address - Phone:806-922-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCABA-024-15416106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst