Provider Demographics
NPI:1699527226
Name:PEREZ RODRIGUEZ, MARLY SUJEY
Entity type:Individual
Prefix:
First Name:MARLY
Middle Name:SUJEY
Last Name:PEREZ RODRIGUEZ
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 1:201 BONNIE BLVD APT 223
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1324
Mailing Address - Country:US
Mailing Address - Phone:786-820-1510
Mailing Address - Fax:
Practice Address - Street 1:201 BONNIE BLVD APT 223
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-1324
Practice Address - Country:US
Practice Address - Phone:786-820-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician