Healthcare Provider Details

I. General information

NPI: 1285305441
Provider Name (Legal Business Name): MAGDA HEJAZIMANESH RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 SW 23RD LN
MIAMI FL
33185-5700
US

IV. Provider business mailing address

15251 SW 23RD LN
MIAMI FL
33185-5700
US

V. Phone/Fax

Practice location:
  • Phone: 52-273-0933
  • Fax: 786-279-0915
Mailing address:
  • Phone: 305-227-3093
  • Fax: 786-279-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-1221109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: