MEDICARE: JUAN CARLOS CASNEIRO LA O

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	:	1689530495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS CASNEIRO LA O

Provider Business Mailing Address
First Line	:	2900 N 24TH AVE APT 1307
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-1461
Country	:	US
Telephone Number	:	786-560-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 N 24TH AVE APT 1307
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-1461
Country	:	US
Telephone Number	:	786-560-3005
Fax Number	:

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

Provider Enumeration Date	:	12/25/2025
Last Update Date	:	12/25/2025

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