MEDICARE: ERIKA ANGELINA FUNG CAMPOS BS

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

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	:	1649795030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA ANGELINA FUNG CAMPOS BS

Provider Business Mailing Address
First Line	:	4575 SE DIXIE HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-6826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 SUNSENT DRIVE, SUITE 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3657
Country	:	US
Telephone Number	:	305-508-5580
Fax Number	:

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	04/22/2019

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