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NPI Code Detail

MEDICARE: SUSEL BOFILL GARCIA

MEDICARE: SUSEL BOFILL GARCIA
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
1106S00000XBehavior TechnicianRBT-20-149599FL

General Provider Information

NPI Number : 1063225647
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSEL BOFILL GARCIA
Provider Business Mailing Address
First Line : 8451 MANTA RAY CIR
Second Line :
City : CYPRESS
State : TX
Zip : 77433-3228
Country : US
Telephone Number : 281-815-5403
Fax Number :
Provider Business Practice Location Address
First Line : 8451 MANTA RAY CIR
Second Line :
City : CYPRESS
State : TX
Zip : 77433-3228
Country : US
Telephone Number : 281-815-5403
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2025
Last Update Date : 01/28/2025

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Directions to “ SUSEL BOFILL GARCIA ” Practice Location

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