Provider Demographics
NPI:1336947571
Name:PEREZ PUENTES, SUSLEIDY
Entity type:Individual
Prefix:
First Name:SUSLEIDY
Middle Name:
Last Name:PEREZ PUENTES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CRESTVIEW DR UNIT 205
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2735
Mailing Address - Country:US
Mailing Address - Phone:239-207-8475
Mailing Address - Fax:
Practice Address - Street 1:725 CRESTVIEW DR UNIT 205
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2735
Practice Address - Country:US
Practice Address - Phone:239-207-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician