Provider Demographics
NPI:1316083710
Name:PERDOMO, LUZ VICTORIA (OTR)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:VICTORIA
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 SW 104TH ST
Mailing Address - Street 2:104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3339
Mailing Address - Country:US
Mailing Address - Phone:786-488-2128
Mailing Address - Fax:
Practice Address - Street 1:10900 SW 104TH ST
Practice Address - Street 2:104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3301
Practice Address - Country:US
Practice Address - Phone:786-488-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist