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General NPI Number Information
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NPI Number | 1083314652
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Entity Type | Organization
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Legal Business Name | BRILLIANT BLUE BEHAVIOR ANALYSIS LLC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 11285 SW 211TH ST STE 203
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City | MIAMI
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State | FL
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Zip | 33189-2213
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Country | US
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Telephone | 786-404-3114
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Fax |
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Provider Business Mailing Address
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Address Line | 13100 SW 262ND LN
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City | HOMESTEAD
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State | FL
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Zip | 33032-8924
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Country | US
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Telephone | 786-404-3114
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Fax | 786-404-3124
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Authorized Official
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Title or Position | OWNER
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Name | VIVIANA FERNANDEZ
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Credential |
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Telephone | 786-509-3700
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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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