Healthcare Provider Details

I. General information

NPI: 1124637996
Provider Name (Legal Business Name): BACARO INNOVATIVE THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 W 70TH ST
HIALEAH FL
33016-5441
US

IV. Provider business mailing address

2459 W 70TH ST
HIALEAH FL
33016-5441
US

V. Phone/Fax

Practice location:
  • Phone: 786-571-0939
  • Fax:
Mailing address:
  • Phone: 786-571-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANIETT BACARO MARRERO
Title or Position: OWNER
Credential: BCBA
Phone: 786-571-0939