MEDICARE: JOSE MIGUEL SOUTO GUERRA

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	390200000X	Student in an Organized Health Care Education/Training Program		FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1396588851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE MIGUEL SOUTO GUERRA

Provider Business Mailing Address
First Line	:	6460 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4139
Country	:	US
Telephone Number	:	754-270-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	6460 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4139
Country	:	US
Telephone Number	:	754-270-8563
Fax Number	:

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

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	04/12/2026

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