Healthcare Provider Details

I. General information

NPI: 1043077258
Provider Name (Legal Business Name): JOEL ANTONIO TRIGOURA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12966 SW 133RD CT
MIAMI FL
33186-6173
US

IV. Provider business mailing address

3890 NW 1ST ST
MIAMI FL
33126-5704
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-6203
  • Fax:
Mailing address:
  • Phone: 786-308-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: