Healthcare Provider Details

I. General information

NPI: 1083915938
Provider Name (Legal Business Name): JOHN M BRIERE-SALTIS BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6869 SOUTHPOINT DRIVE NR SUITE 103
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

6869 SOUTHPOINT DRIVE NR SUITE 103
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax: 902-212-0309
Mailing address:
  • Phone: 904-619-6071
  • Fax: 902-212-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: