Healthcare Provider Details

I. General information

NPI: 1649991019
Provider Name (Legal Business Name): KEIANA ZOOBI-GRIFFEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 NE PINE ISLAND RD STE 7E-F
CAPE CORAL FL
33909-2135
US

IV. Provider business mailing address

2908 36TH ST SW
LEHIGH ACRES FL
33976-4524
US

V. Phone/Fax

Practice location:
  • Phone: 239-599-8733
  • Fax: 239-599-8602
Mailing address:
  • Phone: 970-985-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-233048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: