Healthcare Provider Details

I. General information

NPI: 1639846843
Provider Name (Legal Business Name): LAURA ESPINOSA BOSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 SW 56TH ST STE A202
MIAMI FL
33165-7095
US

IV. Provider business mailing address

10250 SW 56TH ST STE A202
MIAMI FL
33165-7095
US

V. Phone/Fax

Practice location:
  • Phone: 888-527-8037
  • Fax:
Mailing address:
  • Phone: 888-527-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-121179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: