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NPI Code Detail

MEDICARE: GIANCARLO OJEDA SANJURJO BCABA

MEDICARE: GIANCARLO OJEDA SANJURJO BCABA
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
1106E00000XAssistant Behavior Analyst0-20-11159FL
2106S00000XBehavior TechnicianRBT-17-32968FL
3247200000XOther Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215489901
Entity Type Code : Individual
Provider Name (Legal Business Name) : GIANCARLO OJEDA SANJURJO BCABA
Provider Business Mailing Address
First Line : 125 E NASA BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1900
Country : US
Telephone Number : 321-372-6813
Fax Number : 321-765-6434
Provider Business Practice Location Address
First Line : 2180 JULIAN AVE NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4020
Country : US
Telephone Number : 321-372-6813
Fax Number : 321-765-6434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2016
Last Update Date : 07/08/2020

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Directions to “ GIANCARLO OJEDA SANJURJO BCABA” Practice Location

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