Healthcare Provider Details

I. General information

NPI: 1699202994
Provider Name (Legal Business Name): SALMA I JARAMILLO FREIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 02/03/2025
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 SW SAVONA BOULEVARD
PORT SAINT LUCIE FL
34953
US

IV. Provider business mailing address

2302 SW SAVONA BLVD
PORT SAINT LUCIE FL
34953-2213
US

V. Phone/Fax

Practice location:
  • Phone: 786-450-0746
  • Fax:
Mailing address:
  • Phone: 786-450-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: