Healthcare Provider Details

I. General information

NPI: 1942185038
Provider Name (Legal Business Name): JOSUE IZQUIERDO MARIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 S JOHN YOUNG PKWY STE 203
KISSIMMEE FL
34741-0605
US

IV. Provider business mailing address

5091 SILVER THISTLE LN
SAINT CLOUD FL
34772-7072
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-6255
  • Fax: 407-201-7195
Mailing address:
  • Phone: 682-306-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: