MEDICARE: JACQUELINE BEATRIZ VALDES CHAVEZ

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	:	1356891550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BEATRIZ VALDES CHAVEZ

Provider Business Mailing Address
First Line	:	10345 SW 135TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-2842
Country	:	US
Telephone Number	:	786-800-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	18505 NW 75TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2961
Country	:	US
Telephone Number	:	786-479-0029
Fax Number	:

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

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	06/11/2020

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