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General NPI Number Information
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NPI Number | 1073840351
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Entity Type | Organization
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Legal Business Name | BEHAVERUS INC.
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Dates
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Enumeration Date | 11/07/2009
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 9542 BRACKIN ST
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City | ORLANDO
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State | FL
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Zip | 32825-6124
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Country | US
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Telephone | 407-579-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 9542 BRACKIN ST
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City | ORLANDO
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State | FL
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Zip | 32825-6124
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Country | US
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Telephone | 407-579-2507
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MILDRED MILAGROS FERNANDEZ
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Credential | FL-CBA
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Telephone | 407-579-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 0215
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License Number State | FL
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