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General NPI Number Information
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NPI Number | 1063195717
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Entity Type | Individual
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Provider Name | JESSICA TOMAS
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Gender | Female
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 2615 FAIRWAYS DR
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City | HOMESTEAD
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State | FL
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Zip | 33035-1173
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Country | US
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Telephone | 786-578-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 14357 SW 62ND ST
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City | MIAMI
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State | FL
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Zip | 33183-1907
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Country | US
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Telephone | 786-578-3660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 23-286361
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License Number State | FL
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