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General NPI Number Information
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NPI Number | 1740935055
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Entity Type | Individual
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Provider Name | PHIPPS MOHAMA MONCHER
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Gender | Male
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 13650 NW 8TH ST STE 109
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City | SUNRISE
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State | FL
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Zip | 33325-6239
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Country | US
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Telephone | 800-754-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 4540 NW 36TH ST APT 310
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-6445
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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 | RBT-22-202838
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License Number State | FL
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