Healthcare Provider Details

I. General information

NPI: 1497345870
Provider Name (Legal Business Name): FOUNAISENICA JULIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE
MIAMI FL
33193-5826
US

IV. Provider business mailing address

1725 PALM COVE BLVD APT 103
DELRAY BEACH FL
33445-6772
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-6500
  • Fax:
Mailing address:
  • Phone: 561-774-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-150707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: