NPIMap

Individual provider Active NPI

Bianca Irene Perez

  • Behavior Analyst
  • Orlando, FL
National Provider Identifier
1609523596
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-24-72268 Issued in FL
Practice address
5959 Lake Ellenor Dr
Orlando, FL 32809-4633
Phone
(321) 972-4039
NPI assigned
Mar 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT21156579 FL
Behavior Analyst 103K00000X 1-24-72268 FL Primary

Addresses

Primary practice location

5959 Lake Ellenor Dr
Orlando, FL 32809-4633

Mailing address

1612 Sunburst Way
Kissimmee, FL 34744-3711
Phone (407) 493-3095

Other practice location 1

611 N Summerlin Ave Apt 1
Orlando, FL 32803-4699
Phone (407) 493-3095

Other identifiers 1

IdentifierTypeStateIssuer
109643300MedicaidFL

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
RBT21156579FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Camen Behavioral Services, LLC Behavior Analyst Past Accepting new patients
Camen Behavioral Services, LLC Behavior Analyst Past Accepting new patients
Camen Behavioral Services, LLC Behavior Analyst Past Accepting new patients
Action Behavior Centers Therapy LLC Behavior Analyst Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1609523596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 SUNBURST WAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347443711",
            "telephone_number": "407-493-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 LAKE ELLENOR DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094633",
            "telephone_number": "321-972-4039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 N Summerlin Ave Apt 1",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328034699",
            "country_code": "US",
            "telephone_number": "407-493-3095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "BIANCA",
        "middle_name": "IRENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-09",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT21156579",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-24-72268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109643300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.