MEDICARE: EUNICE SAMIRA HAZIM-POKORSKI

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	106S00000X	Behavior Technician

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	:	1265878144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE SAMIRA HAZIM-POKORSKI

Provider Business Mailing Address
First Line	:	175 MIDDLE ST UNIT 1201
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3625
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	7326 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5518
Country	:	US
Telephone Number	:	727-364-2216
Fax Number	:

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

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	09/21/2018

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