Provider Demographics
NPI:1508742024
Name:PEREZ PEDRAZA, GEISI
Entity type:Individual
Prefix:
First Name:GEISI
Middle Name:
Last Name:PEREZ PEDRAZA
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 1:4323 BAYSIDE VILLAGE DR APT 219
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5584
Mailing Address - Country:US
Mailing Address - Phone:786-572-9159
Mailing Address - Fax:
Practice Address - Street 1:4323 BAYSIDE VILLAGE DR APT 219
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5584
Practice Address - Country:US
Practice Address - Phone:813-378-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP6234735010001041C0700X
FLRBT-25-404668106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical