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General NPI Number Information
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NPI Number | 1649744038
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Entity Type | Individual
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Provider Name | KRISTAN KEVIN SAN JUAN BCABA
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 777 BRICKELL AVE STE 500
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City | MIAMI
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State | FL
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Zip | 33131-2803
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Country | US
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Telephone | 786-239-6373
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Fax |
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Provider Business Mailing Address
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Address Line | 4774 SW 154TH AVE
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City | MIAMI
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State | FL
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Zip | 33185-4428
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Country | US
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Telephone | 786-239-6373
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-18-9202
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-56167
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License Number State | FL
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