Provider Demographics
NPI:1316302300
Name:PEREZ, SARA ELIZABETH (RBT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 OSUNA RD NE APT 511
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2564
Mailing Address - Country:US
Mailing Address - Phone:956-245-9182
Mailing Address - Fax:
Practice Address - Street 1:5741 OSUNA RD NE APT 511
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2564
Practice Address - Country:US
Practice Address - Phone:956-245-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27797995106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM373H00000XOtherCMS