Provider Demographics
NPI:1588370878
Name:PEREZ ALVAREZ, ANISLEYDI
Entity type:Individual
Prefix:
First Name:ANISLEYDI
Middle Name:
Last Name:PEREZ ALVAREZ
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 1:3701 WINKLER AVE APT 313
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-7703
Mailing Address - Country:US
Mailing Address - Phone:561-597-4184
Mailing Address - Fax:
Practice Address - Street 1:3701 WINKLER AVE APT 313
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-7703
Practice Address - Country:US
Practice Address - Phone:561-597-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-156665106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician