Provider Demographics
NPI:1972380772
Name:PICHIN FRANCO, MAURICIO ALFONSO
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:ALFONSO
Last Name:PICHIN FRANCO
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 1:8520 NW 190TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5382
Mailing Address - Country:US
Mailing Address - Phone:786-368-7185
Mailing Address - Fax:
Practice Address - Street 1:8520 NW 190TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5382
Practice Address - Country:US
Practice Address - Phone:786-368-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-296770106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician