Provider Demographics
NPI:1194553693
Name:SAMPEDRO, JOHN CARLOS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARLOS
Last Name:SAMPEDRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 SW 168TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2149
Mailing Address - Country:US
Mailing Address - Phone:786-319-1740
Mailing Address - Fax:
Practice Address - Street 1:12030 SW 168TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2149
Practice Address - Country:US
Practice Address - Phone:786-319-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician