MEDICARE: KIMORA CLAUDE COREUS

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-24-369124	FL

General Provider Information

NPI Number	:	1700692696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMORA CLAUDE COREUS

Provider Business Mailing Address
First Line	:	3471 NW 43RD PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4240
Country	:	US
Telephone Number	:	754-971-1722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3471 NW 43RD PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4240
Country	:	US
Telephone Number	:	754-971-1722
Fax Number	:

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

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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Directions to “ KIMORA CLAUDE COREUS ” Practice Location

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