Provider Demographics
NPI:1548090418
Name:JARQUIN, KEVIN OSVALDO
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:OSVALDO
Last Name:JARQUIN
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 1:5755 W 20TH AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7544
Mailing Address - Country:US
Mailing Address - Phone:786-709-5275
Mailing Address - Fax:
Practice Address - Street 1:5911 NW 173RD DR UNIT 11
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5122
Practice Address - Country:US
Practice Address - Phone:786-655-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician