Healthcare Provider Details

I. General information

NPI: 1013845726
Provider Name (Legal Business Name): JAZMIN AZAMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19479 NW 24TH PL
PEMBROKE PINES FL
33029-5370
US

IV. Provider business mailing address

19479 NW 24TH PL
PEMBROKE PINES FL
33029-5370
US

V. Phone/Fax

Practice location:
  • Phone: 786-382-9743
  • Fax:
Mailing address:
  • Phone: 786-382-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-530067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: