MEDICARE: JOSE CARLOS CANIZARES CABRERA

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	106S00000X	Behavior Technician	RBT-24-360272	FL

General Provider Information

NPI Number	:	1184452757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE CARLOS CANIZARES CABRERA

Provider Business Mailing Address
First Line	:	11289 NW 88TH AVE
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11289 NW 88TH AVE
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4530
Country	:	US
Telephone Number	:	305-347-9863
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	03/25/2026

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