Individual provider Active NPI

Miriam Iliana Perdomo DO Vale

  • Behavior Technician
  • Pembroke Pines, FL
National Provider Identifier
1417570755
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
RBT-20-117702 Issued in FL
Practice address
8831 NW 13TH St
Pembroke Pines, FL 33024-4718
Phone
(425) 414-2938
NPI assigned
May 21, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-20-117702 FL Primary

Addresses

Primary practice location

8831 NW 13TH St
Pembroke Pines, FL 33024-4718

Mailing address

8831 NW 13TH St
Pembroke Pines, FL 33024-4718
Phone (425) 414-2938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RBT-20-117702FLMDBehavior Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1417570755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8831 NW 13TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330244718",
            "telephone_number": "425-414-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8831 NW 13TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330244718",
            "telephone_number": "425-414-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERDOMO DO VALE",
        "first_name": "MIRIAM",
        "middle_name": "ILIANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-21",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-20-117702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.