MEDICARE: TOMAS FERNANDEZ CARVAJAL

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

General Provider Information

NPI Number	:	1265207617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMAS FERNANDEZ CARVAJAL

Provider Business Mailing Address
First Line	:	38 SE 13TH ST
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4329
Country	:	US
Telephone Number	:	754-259-2889
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 W COMMERCIAL BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2155
Country	:	US
Telephone Number	:	754-232-2026
Fax Number	:

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

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	11/15/2023

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