Healthcare Provider Details

I. General information

NPI: 1245888585
Provider Name (Legal Business Name): MILA DE LA CARIDAD BROCHE COEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26091 EAVERSON RD
PUNTA GORDA FL
33955-1437
US

IV. Provider business mailing address

26091 EAVERSON RD
PUNTA GORDA FL
33955-1437
US

V. Phone/Fax

Practice location:
  • Phone: 941-354-9229
  • Fax:
Mailing address:
  • Phone: 941-354-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: