MEDICARE: GHINELLE MONCOEUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0-03-1038	FL

General Provider Information

NPI Number	:	1053762039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHINELLE MONCOEUR

Provider Business Mailing Address
First Line	:	PO BOX 611565
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33261-1565
Country	:	US
Telephone Number	:	786-499-7942
Fax Number	:

Provider Business Practice Location Address
First Line	:	14000 W DIXIE HWY
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3443
Country	:	US
Telephone Number	:	786-499-7942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	06/30/2016

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