MEDICARE: ISIDORA PAZ CHEVESICH

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	103K00000X	FL

General Provider Information

NPI Number	:	1215583315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIDORA PAZ CHEVESICH

Provider Business Mailing Address
First Line	:	927 N 14TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3712
Country	:	US
Telephone Number	:	786-580-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 N 14TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3712
Country	:	US
Telephone Number	:	786-580-6140
Fax Number	:

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

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	08/14/2019

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Directions to “ ISIDORA PAZ CHEVESICH ” Practice Location

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