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NPI Code Detail

MEDICARE: KEVIN JIMENEZ BRAVO

MEDICARE: KEVIN JIMENEZ BRAVO
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 Technician

General Provider Information

NPI Number : 1154090082
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN JIMENEZ BRAVO
Provider Business Mailing Address
First Line : 15363 SW 69TH TER
Second Line :
City : MIAMI
State : FL
Zip : 33193-2208
Country : US
Telephone Number : 786-635-6606
Fax Number :
Provider Business Practice Location Address
First Line : 18646 NW 53RD AVE
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33055-5307
Country : US
Telephone Number : 786-458-0031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2021
Last Update Date : 09/13/2021

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Directions to “ KEVIN JIMENEZ BRAVO ” Practice Location

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