MEDICARE: SAMLIS SAMUELL BOUZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	106E00000X	Assistant Behavior Analyst
3	103K00000X	Behavior Analyst

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	:	1639422041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMLIS SAMUELL BOUZA

Provider Business Mailing Address
First Line	:	3121 SW 140TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6504
Country	:	US
Telephone Number	:	305-790-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 SW 140TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6504
Country	:	US
Telephone Number	:	305-790-9504
Fax Number	:

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

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	12/18/2023

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Directions to “ SAMLIS SAMUELL BOUZA ” Practice Location

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