Provider Demographics
NPI:1275301673
Name:TOIRAC MATAMOROS, KARINA ISABEL
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ISABEL
Last Name:TOIRAC MATAMOROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18203 NW 40TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3416
Mailing Address - Country:US
Mailing Address - Phone:786-909-7509
Mailing Address - Fax:
Practice Address - Street 1:18203 NW 40TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3416
Practice Address - Country:US
Practice Address - Phone:786-909-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-315334106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty