Provider Demographics
NPI:1518248038
Name:BRITO, CHRISTIAN S
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:S
Last Name:BRITO
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 1:11276 SW 232ND ST
Mailing Address - Street 2:
Mailing Address - City:GOULDS
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7505
Mailing Address - Country:US
Mailing Address - Phone:305-912-8399
Mailing Address - Fax:305-508-6537
Practice Address - Street 1:11276 SW 232ND ST
Practice Address - Street 2:
Practice Address - City:GOULDS
Practice Address - State:FL
Practice Address - Zip Code:33170
Practice Address - Country:US
Practice Address - Phone:305-912-8399
Practice Address - Fax:305-508-6537
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017519100Medicaid