Healthcare Provider Details

I. General information

NPI: 1598677825
Provider Name (Legal Business Name): KENDRI JOSUE CHIRINO MONTERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 W LUMSDEN RD
BRANDON FL
33511-6260
US

IV. Provider business mailing address

792 W LUMSDEN RD
BRANDON FL
33511-6260
US

V. Phone/Fax

Practice location:
  • Phone: 813-324-7538
  • Fax: 813-324-7538
Mailing address:
  • Phone: 813-324-7538
  • Fax: 813-324-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2845862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: