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NPI Code Detail

MEDICARE: MS. CHARLOTTE DA CRUZ MIREBEAU

MEDICARE: MS. CHARLOTTE DA CRUZ MIREBEAU
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
1106E00000XAssistant Behavior AnalystM610104966220FL

General Provider Information

NPI Number : 1063944130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHARLOTTE DA CRUZ MIREBEAU
Provider Business Mailing Address
First Line : 498 SW 6TH ST APT 403
Second Line :
City : MIAMI
State : FL
Zip : 33130-2996
Country : US
Telephone Number : 786-300-8894
Fax Number :
Provider Business Practice Location Address
First Line : 419 W 49TH ST STE 212
Second Line :
City : HIALEAH
State : FL
Zip : 33012-3657
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2017
Last Update Date : 03/29/2017

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