=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003694910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE COLORS PROFESSIONAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2023
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7225 NW 25TH ST STE 111
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-868-7397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7225 NW 25TH ST STE 111
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-868-7397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BELKIS VAZQUEZ VALDES
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 786-868-7397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------