Healthcare Provider Details

I. General information

NPI: 1376126599
Provider Name (Legal Business Name): CAMILA BOURZAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 SW 112TH AVE
MIAMI FL
33176-8273
US

IV. Provider business mailing address

12900 SW 192ND ST
MIAMI FL
33177-3736
US

V. Phone/Fax

Practice location:
  • Phone: 305-699-3241
  • Fax:
Mailing address:
  • Phone: 786-259-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: