| Brilliant Blue | |
|
100 Ne 15th St Ste 209 Homestead FL 33030-4581 | |
| (786) 509-3700 | |
| Not Available |
| Full Name | Brilliant Blue |
|---|---|
| Speciality | Behavior Technician |
| Location | 100 Ne 15th St Ste 209, Homestead, Florida |
| Authorized Official Name and Position | Viviana Fernandez (PRESIDENT) |
| Authorized Official Contact | 7865093700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brilliant Blue 13100 Sw 262nd Ln Homestead FL 33032-8924 Ph: (786) 404-3479 | Brilliant Blue 100 Ne 15th St Ste 209 Homestead FL 33030-4581 Ph: (786) 509-3700 |
| NPI Number | 1083314652 |
|---|---|
| Provider Enumeration Date | 03/03/2023 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083314652 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106S00000X | Behavior Technician | (* (Not Available)) | Primary |
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