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Ilen Perdomo Carmona

Behavior Technician

Behavioral Health & Social Service Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Ilen Perdomo Carmona does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1699251595
Provider Type
Individual
Full Name
Perdomo Carmona, Ilen
Gender
Female

Sole Proprietor
Yes
Enumeration Date
7/13/2018
Last Updated
1/25/2021

Contact Information

Practice Location

3799 SW 148th Ct, Miami, FL 33185-3901

(786) 879-9550

Unlisted Fax

Mailing Location

3799 SW 148th Ct, Miami, FL 33185-3901

(786) 879-9550

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106S00000X Primary	Description Behavior Technician Behavioral Health & Social Service Providers	License RBT1867920 Florida
Code 106S00000X	Description Behavior Technician Behavioral Health & Social Service Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 022422300	Description Medicaid	Issuer Unlisted Florida

Ilen Perdomo Carmona

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Barragan, Marbe Luz

Gomez Hung, Janys C

Garcia, Yuliana

Alvarez Gonzalez, Yusleidy

Gonzalez, Stephanie

Ceballos Linares, Yanaisa

Angulo, Yaransy

Ortiz, Jayden

Perez, Nelson

Aparicio Irarragorri, Liliana