Provider Demographics
NPI:1619729951
Name:MANZANAL CAPIRO, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:MANZANAL CAPIRO
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 1:10985 SW 214TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3153
Mailing Address - Country:US
Mailing Address - Phone:786-414-6795
Mailing Address - Fax:
Practice Address - Street 1:10985 SW 214TH ST APT 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-3153
Practice Address - Country:US
Practice Address - Phone:786-414-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-329273106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician