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General NPI Number Information
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NPI Number | 1912669458
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Entity Type | Individual
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Provider Name | LUIS MIGUEL TAVERAS
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Gender | Male
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 500 S AUSTRALIAN AVE STE 600
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6237
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Country | US
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Telephone | 877-857-8517
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Fax |
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Provider Business Mailing Address
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Address Line | 7694 BLAIRWOOD CIR S
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City | LAKE WORTH
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State | FL
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Zip | 33467-1806
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Country | US
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Telephone | 786-626-1692
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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-21-189174
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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 | 1-25-78881
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License Number State | FL
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