Provider Demographics
NPI:1851993679
Name:TENORIO AMBRUSTER, JOSE MIGUEL
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:TENORIO AMBRUSTER
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 1:22772 SW 103RD CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1778
Mailing Address - Country:US
Mailing Address - Phone:786-285-3301
Mailing Address - Fax:
Practice Address - Street 1:22772 SW 103RD CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1778
Practice Address - Country:US
Practice Address - Phone:786-285-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst