=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275342628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES E WAITERS JR. RBT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2024
-----------------------------------------------------
Last Update Date | 12/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14221 SW 120TH ST STE 214
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-452-1185
-----------------------------------------------------
Fax | 786-703-7973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5930 NW 5TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-1271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-419-7165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | BACB1182348
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------