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General NPI Number Information
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NPI Number | 1477262723
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIOR SERVICES ABA LLC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 25001 SW 127TH AVE STE 202
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City | HOMESTEAD
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State | FL
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Zip | 33032-5834
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Country | US
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Telephone | 786-286-1452
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Fax |
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Provider Business Mailing Address
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Address Line | 13220 SW 271ST TER
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City | HOMESTEAD
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State | FL
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Zip | 33032-8592
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Country | US
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Telephone | 786-286-1452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL PARDO TARRERO
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Credential |
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Telephone | 786-286-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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