Healthcare Provider Details

I. General information

NPI: 1184540122
Provider Name (Legal Business Name): BRAYAN LLERENA MATOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 W FLAGLER ST STE 121
MIAMI FL
33144-2035
US

IV. Provider business mailing address

3230 NW 3RD ST
MIAMI FL
33125-4902
US

V. Phone/Fax

Practice location:
  • Phone: 305-600-4774
  • Fax: 305-428-3110
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: