MEDICARE: MEIBIS JUAN ZAMORA

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	24359641	FL

General Provider Information

NPI Number	:	1568292894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEIBIS JUAN ZAMORA

Provider Business Mailing Address
First Line	:	7095 NW 179TH ST APAT 101
Second Line	:	EDIF 7
City	:	HIALEAH
State	:	FL
Zip	:	33015-5419
Country	:	US
Telephone Number	:	305-310-6304
Fax Number	:

Provider Business Practice Location Address
First Line	:	7095 NW 179TH ST APAT 101
Second Line	:	EDIF 7
City	:	HIALEAH
State	:	FL
Zip	:	33015-5419
Country	:	US
Telephone Number	:	305-310-6304
Fax Number	:

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

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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Directions to “ MEIBIS JUAN ZAMORA ” Practice Location

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