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General NPI Number Information
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NPI Number | 1942185038
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Entity Type | Individual
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Provider Name | JOSUE IZQUIERDO MARIN
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Gender | Male
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1975 S JOHN YOUNG PKWY STE 203
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City | KISSIMMEE
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State | FL
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Zip | 34741-0605
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Country | US
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Telephone | 407-201-6255
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Fax | 407-201-7195
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Provider Business Mailing Address
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Address Line | 5091 SILVER THISTLE LN
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City | SAINT CLOUD
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State | FL
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Zip | 34772-7072
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Country | US
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Telephone | 682-306-8483
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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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