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General NPI Number Information
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NPI Number | 1447803697
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Entity Type | Individual
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Provider Name | FREDDIE PANEQUE JAMET SR. RBT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 4271 NW SOUTH TAMIAMI CANAL DR APT 102
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City | MIAMI
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State | FL
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Zip | 33126-1447
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Country | US
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Telephone | 786-253-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 W 58TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-6264
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Country | US
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Telephone | 786-253-2616
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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 | 1-24-70982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-92661
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License Number State | FL
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