MEDICARE: JAVIER HERRERA

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
2	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1609386986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER HERRERA

Provider Business Mailing Address
First Line	:	1304 NW 31ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1937
Country	:	US
Telephone Number	:	305-384-0610
Fax Number	:	305-742-2190

Provider Business Practice Location Address
First Line	:	1304 NW 31ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1937
Country	:	US
Telephone Number	:	305-384-0610
Fax Number	:	305-742-2190

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	08/21/2020

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Directions to “ JAVIER HERRERA ” Practice Location

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