| Doctor Name: | WANDA NOEMI PEREZ |
| NPI Number: | 1144661869 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | ISW 3647 |
| Business Practice Address: | 1825 Nw 167th St Suite 102 Miami Gardens, FL - 330564838 |
| Business Phone Number: | 3056247450 |
| Business Fax Number: | 3056237893 |
| Mailing Address: | 1825 Nw 167th St, Suite 102 MIAMI GARDENS |
| State: | FL |
| Postal Code: | 330564838 |
| Phone Number: | 3056247450 |
| Fax Number: | 3056237893 |
| NPI Enumeration Date: | 07/10/2013 |
| NPI Last Update Date: | 07/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | ISW 3647 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |