Provider Demographics
NPI:1992272579
Name:PERAZA GOICOLEA, JOSE ANTONIO (BCABA)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:PERAZA GOICOLEA
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5934
Mailing Address - Country:US
Mailing Address - Phone:786-410-8922
Mailing Address - Fax:
Practice Address - Street 1:70 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5934
Practice Address - Country:US
Practice Address - Phone:786-410-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-11615106E00000X
FL1-21-54861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst