MEDICARE: MILA DE LA CARIDAD BROCHE COEGO

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
1	106E00000X	Assistant Behavior Analyst	0-23-14717	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245888585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILA DE LA CARIDAD BROCHE COEGO

Provider Business Mailing Address
First Line	:	201 NW 72ND AVE APT 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4314
Country	:	US
Telephone Number	:	786-343-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 NW 72ND AVE APT 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4314
Country	:	US
Telephone Number	:	786-343-1785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/24/2024

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Directions to “ MILA DE LA CARIDAD BROCHE COEGO ” Practice Location

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