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General NPI Number Information
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NPI Number | 1255277729
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Entity Type | Individual
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Provider Name | LIDA BREIJO
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Gender | Female
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 1616 JORK RD STE 401-402
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2491
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Country | US
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Telephone | 904-662-7093
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Fax |
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Provider Business Mailing Address
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Address Line | 8181 A C SKINNER PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5216
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Country | US
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Telephone | 717-205-7813
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-25-480653
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License Number State | FL
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