Provider Demographics
NPI:1093365983
Name:BEGUELIN JARA, EDUARDO DANIEL
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:DANIEL
Last Name:BEGUELIN JARA
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 1:16860 SW 137TH AVE APT 436
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2472
Mailing Address - Country:US
Mailing Address - Phone:786-306-9210
Mailing Address - Fax:
Practice Address - Street 1:13301 SW 132ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6188
Practice Address - Country:US
Practice Address - Phone:786-713-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-98821106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician