MEDICARE: VIRGINIA BEAUZAY

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

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	:	1871941666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA BEAUZAY

Provider Business Mailing Address
First Line	:	11890 SW 8TH ST STE 309
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-1710
Country	:	US
Telephone Number	:	305-220-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	12855 SW 132ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-7207
Country	:	US
Telephone Number	:	786-587-0424
Fax Number	:

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

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	10/22/2018

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Directions to “ VIRGINIA BEAUZAY ” Practice Location

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