MEDICARE: JESUS MCCAIN

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	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1821535584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS MCCAIN

Provider Business Mailing Address
First Line	:	4001SW 52ND AVE APT 201
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023
Country	:	US
Telephone Number	:	786-879-9564
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 SW 52ND AVE APT 201
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-6945
Country	:	US
Telephone Number	:	786-879-9564
Fax Number	:

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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Directions to “ JESUS MCCAIN ” Practice Location

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