Healthcare Provider Details

I. General information

NPI: 1306776935
Provider Name (Legal Business Name): JAIME MADRUGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27521 SW 164TH CT
HOMESTEAD FL
33031-2858
US

IV. Provider business mailing address

27521 SW 164TH CT
HOMESTEAD FL
33031-2858
US

V. Phone/Fax

Practice location:
  • Phone: 305-338-0805
  • Fax:
Mailing address:
  • Phone: 305-338-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-538681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: