Provider Demographics
NPI:1386952596
Name:PEREZ HENRIQUEZ, CARLOS NAVAL I (MS-SLP)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:NAVAL
Last Name:PEREZ HENRIQUEZ
Suffix:I
Gender:M
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 SW 128TH CT STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4665
Mailing Address - Country:US
Mailing Address - Phone:786-732-6983
Mailing Address - Fax:
Practice Address - Street 1:12001 SW 128TH CT STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4665
Practice Address - Country:US
Practice Address - Phone:786-732-6983
Practice Address - Fax:305-387-4467
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008422800Medicaid