Provider Demographics
NPI:1972290294
Name:PEREZ TEJON, MARIANELA
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:PEREZ TEJON
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 1:1111 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5502
Mailing Address - Country:US
Mailing Address - Phone:786-506-5485
Mailing Address - Fax:
Practice Address - Street 1:1111 DREXEL RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-5502
Practice Address - Country:US
Practice Address - Phone:786-506-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-264611106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician