Healthcare Provider Details

I. General information

NPI: 1164896106
Provider Name (Legal Business Name): JOSE KOIVU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 05/31/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 NW 37TH ST
MIAMI FL
33127-3111
US

IV. Provider business mailing address

3900 NW 79TH AVE SUITE 501
DORAL FL
33166-6556
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-1924
  • Fax:
Mailing address:
  • Phone: 305-597-3861
  • Fax: 305-597-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: