Provider Demographics
NPI:1407488919
Name:MONTEAGUDO PEREZ, YASSIN
Entity type:Individual
Prefix:
First Name:YASSIN
Middle Name:
Last Name:MONTEAGUDO PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 N MISSIONWOOD CIR UNIT 17A
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2936
Mailing Address - Country:US
Mailing Address - Phone:786-212-2024
Mailing Address - Fax:
Practice Address - Street 1:18505 NW 75TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2961
Practice Address - Country:US
Practice Address - Phone:786-479-0029
Practice Address - Fax:786-542-5084
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-111680106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty