Healthcare Provider Details

I. General information

NPI: 1700565249
Provider Name (Legal Business Name): JOSE MULET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 DEL PRADO BLVD S STE 209-2
CAPE CORAL FL
33904-7283
US

IV. Provider business mailing address

345 SW 63RD AVE
MIAMI FL
33144-3139
US

V. Phone/Fax

Practice location:
  • Phone: 239-599-8182
  • Fax:
Mailing address:
  • Phone: 786-602-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-283028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: