Healthcare Provider Details

I. General information

NPI: 1043096944
Provider Name (Legal Business Name): JOSE CARLOS ZUMAQUERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 NE 6TH AVE APT 107
NORTH MIAMI FL
33161-7768
US

IV. Provider business mailing address

13020 NE 6TH AVE APT 107
NORTH MIAMI FL
33161-7768
US

V. Phone/Fax

Practice location:
  • Phone: 786-398-2578
  • Fax:
Mailing address:
  • Phone: 786-398-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-295664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: