Healthcare Provider Details

I. General information

NPI: 1982392064
Provider Name (Legal Business Name): HOLLYWOOD BEHAVIOR CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N FEDERAL HWY
HALLANDALE BEACH FL
33009-2400
US

IV. Provider business mailing address

2724 LINCOLN ST
HOLLYWOOD FL
33020-3846
US

V. Phone/Fax

Practice location:
  • Phone: 786-219-5331
  • Fax:
Mailing address:
  • Phone: 786-219-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VERONIKA HURTADO PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 786-219-5331