Provider Demographics
NPI:1891504759
Name:REYES PEREZ, ESTHER LAZARA
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:LAZARA
Last Name:REYES PEREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 NW 199TH ST LOT 47
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1702
Mailing Address - Country:US
Mailing Address - Phone:786-872-2238
Mailing Address - Fax:
Practice Address - Street 1:4955 NW 199TH ST LOT 47
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1702
Practice Address - Country:US
Practice Address - Phone:786-872-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-367753106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125281400Medicaid