Provider Demographics
NPI:1043096944
Name:ZUMAQUERO, JOSE CARLOS
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:ZUMAQUERO
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 1:13020 NE 6TH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7768
Mailing Address - Country:US
Mailing Address - Phone:786-398-2578
Mailing Address - Fax:
Practice Address - Street 1:13020 NE 6TH AVE APT 107
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7768
Practice Address - Country:US
Practice Address - Phone:786-398-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-295664106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician