Provider Demographics
NPI:1558176784
Name:VICHOT PEREZ, EVIAN
Entity type:Individual
Prefix:
First Name:EVIAN
Middle Name:
Last Name:VICHOT PEREZ
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 1:530 S ESTRIBO ST
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-7633
Mailing Address - Country:US
Mailing Address - Phone:786-400-9041
Mailing Address - Fax:786-212-4567
Practice Address - Street 1:530 S ESTRIBO ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-7633
Practice Address - Country:US
Practice Address - Phone:786-400-9041
Practice Address - Fax:786-212-4567
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-410191106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician