Provider Demographics
NPI:1528804283
Name:PEREZ TORRES, ROLANDO MOISES
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:MOISES
Last Name:PEREZ TORRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-1309
Mailing Address - Country:US
Mailing Address - Phone:561-764-0668
Mailing Address - Fax:
Practice Address - Street 1:125 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-1309
Practice Address - Country:US
Practice Address - Phone:561-764-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician