Provider Demographics
NPI:1982168670
Name:PEREZ, BROOKE C
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:C
Last Name:PEREZ
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 1:9499 COLLINS AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2679
Mailing Address - Country:US
Mailing Address - Phone:954-804-8666
Mailing Address - Fax:
Practice Address - Street 1:1 OAKWOOD BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1937
Practice Address - Country:US
Practice Address - Phone:954-925-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist