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NPI Code Detail

MEDICARE: BRENO WILLIAM LAREDO

MEDICARE:   BRENO WILLIAM LAREDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianFL

General Provider Information

NPI Number : 1043817034
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENO WILLIAM LAREDO
Provider Business Mailing Address
First Line : 431 EXECUTIVE CENTER DR APT 201
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-2966
Country : US
Telephone Number : 561-567-4966
Fax Number :
Provider Business Practice Location Address
First Line : 431 EXECUTIVE CENTER DR APT 201
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-2966
Country : US
Telephone Number : 561-567-4966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2020
Last Update Date : 10/03/2020

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