Provider Demographics
NPI:1689274177
Name:PEREZ, IBRAHIM
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 CYPRESS LAKE PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2208
Mailing Address - Country:US
Mailing Address - Phone:786-281-2463
Mailing Address - Fax:
Practice Address - Street 1:2222 CYPRESS LAKE PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2208
Practice Address - Country:US
Practice Address - Phone:786-281-2463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty