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NPI Code Detail

MEDICARE: SEBASTIAN RAFAEL LARA MATOS

MEDICARE: SEBASTIAN RAFAEL LARA MATOS
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 : 1083548630
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEBASTIAN RAFAEL LARA MATOS
Provider Business Mailing Address
First Line : 4090 HODGES BLVD APT 3209
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-4228
Country : US
Telephone Number : 787-565-0596
Fax Number :
Provider Business Practice Location Address
First Line : 8382 BAYMEADOWS RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4447
Country : US
Telephone Number : 904-755-0646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2026
Last Update Date : 06/10/2026

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Directions to “ SEBASTIAN RAFAEL LARA MATOS ” Practice Location

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