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General NPI Number Information
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NPI Number | 1679107080
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Entity Type | Individual
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Provider Name | CHUKWUEBUKA CHRISANTUS EZURIKE RBT
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Gender | Male
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 10014 N DALE MABRY HWY STE C-100
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City | TAMPA
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State | FL
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Zip | 33618-4426
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Country | US
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Telephone | 800-892-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 BESSIE COLEMAN BLVD # 21802
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City | TAMPA
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State | FL
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Zip | 33630-5009
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Country | US
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Telephone |
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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 | 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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