Healthcare Provider Details

I. General information

NPI: 1306665088
Provider Name (Legal Business Name): MRS. BEATRIZ BUERGO CHAMOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 NW 65TH AVE APT 3
VIRGINIA GARDENS FL
33166-6917
US

IV. Provider business mailing address

3951 NW 65TH AVE APT 3
VIRGINIA GARDENS FL
33166-6917
US

V. Phone/Fax

Practice location:
  • Phone: 786-387-9705
  • Fax:
Mailing address:
  • Phone: 786-387-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: