Provider Demographics
NPI:1245816149
Name:BOULLOSA FUCHS, JOSE ARTURO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ARTURO
Last Name:BOULLOSA FUCHS
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 1:8510 W 40TH AVE APT G207
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2310
Mailing Address - Country:US
Mailing Address - Phone:786-985-4378
Mailing Address - Fax:
Practice Address - Street 1:8510 W 40TH AVE APT G207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2310
Practice Address - Country:US
Practice Address - Phone:786-985-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-120850106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-120850OtherBACB