Provider Demographics
NPI:1417787250
Name:PEREZ LOPEZ, SURY SADAY (CBHCMS)
Entity type:Individual
Prefix:
First Name:SURY
Middle Name:SADAY
Last Name:PEREZ LOPEZ
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 NW 195TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3039
Mailing Address - Country:US
Mailing Address - Phone:786-326-1619
Mailing Address - Fax:
Practice Address - Street 1:18300 NW 62ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-8207
Practice Address - Country:US
Practice Address - Phone:786-953-6729
Practice Address - Fax:786-353-2349
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator