Provider Demographics
NPI:1568292894
Name:JUAN ZAMORA, MEIBIS
Entity type:Individual
Prefix:
First Name:MEIBIS
Middle Name:
Last Name:JUAN ZAMORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 NW 179TH ST APAT 101
Mailing Address - Street 2:EDIF 7
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5419
Mailing Address - Country:US
Mailing Address - Phone:305-310-6304
Mailing Address - Fax:
Practice Address - Street 1:7095 NW 179TH ST APAT 101
Practice Address - Street 2:EDIF 7
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5419
Practice Address - Country:US
Practice Address - Phone:305-310-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24359641106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician