Healthcare Provider Details

I. General information

NPI: 1902732316
Provider Name (Legal Business Name): JASON LOUIS-JACQUES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR
DAVIE FL
33328-5312
US

IV. Provider business mailing address

5348 SW 133RD AVE
MIRAMAR FL
33027-5442
US

V. Phone/Fax

Practice location:
  • Phone: 954-513-9545
  • Fax:
Mailing address:
  • Phone: 508-232-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-545463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: