Provider Demographics
NPI:1285156125
Name:JACAS CARVAJAL, ISRAEL SALVADOR
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:SALVADOR
Last Name:JACAS CARVAJAL
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 1:2251 N 61ST TER
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4219
Mailing Address - Country:US
Mailing Address - Phone:786-380-1894
Mailing Address - Fax:
Practice Address - Street 1:2251 NW 61ST TER
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:786-380-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician