MEDICARE: JONATHAN LAZARO CALERO NUNEZ

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		FL

General Provider Information

NPI Number	:	1639971054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN LAZARO CALERO NUNEZ

Provider Business Mailing Address
First Line	:	777 NW 72ND AVE STE 1083
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3176
Country	:	US
Telephone Number	:	786-490-6307
Fax Number	:

Provider Business Practice Location Address
First Line	:	4432 SW 151ST PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4384
Country	:	US
Telephone Number	:	786-818-6217
Fax Number	:

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

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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