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General NPI Number Information
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NPI Number | 1053188292
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Entity Type | Organization
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Legal Business Name | BRIGHT BLUE THERAPY CORP
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 111 SW 3RD ST STE 608
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City | MIAMI
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State | FL
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Zip | 33130-1926
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Country | US
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Telephone | 786-365-8864
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Fax | 786-365-8864
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Provider Business Mailing Address
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Address Line | 111 SW 3RD ST STE 608
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City | MIAMI
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State | FL
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Zip | 33130-1926
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Country | US
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Telephone | 786-365-8864
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Fax | 786-365-8864
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Authorized Official
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Title or Position | OWNER
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Name | LAZARO FRANCISCO JUNCO RODRIGUEZ
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Credential |
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Telephone | 786-365-8864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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