Provider Demographics
NPI:1487399481
Name:BARRETO PEREZ, YULITZA ELENA
Entity type:Individual
Prefix:
First Name:YULITZA
Middle Name:ELENA
Last Name:BARRETO 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 1:4550 OAKCREEK ST APT 206
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2876
Mailing Address - Country:US
Mailing Address - Phone:786-823-1776
Mailing Address - Fax:
Practice Address - Street 1:467 LAKE HOWELL RD STE 205206
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5922
Practice Address - Country:US
Practice Address - Phone:407-449-2813
Practice Address - Fax:407-386-6897
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-201001106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113463600Medicaid