Provider Demographics
NPI:1386919173
Name:PEREZ HERNANDEZ, ALAIN (CBHCMS)
Entity type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:PEREZ HERNANDEZ
Suffix:
Gender:M
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3122
Mailing Address - Country:US
Mailing Address - Phone:786-368-1112
Mailing Address - Fax:
Practice Address - Street 1:11401 SW 40TH ST STE 345
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3372
Practice Address - Country:US
Practice Address - Phone:305-603-7063
Practice Address - Fax:305-603-8705
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015401600Medicaid