Healthcare Provider Details

I. General information

NPI: 1528505161
Provider Name (Legal Business Name): MELISSA ZURITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13815 DEVAN LEE DR E
JACKSONVILLE FL
32226-5868
US

IV. Provider business mailing address

13815 DEVAN LEE DR E
JACKSONVILLE FL
32226-5868
US

V. Phone/Fax

Practice location:
  • Phone: 904-613-5005
  • Fax: 904-696-9868
Mailing address:
  • Phone: 904-613-5005
  • Fax: 904-696-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-18160
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: