Provider Demographics
NPI:1457131690
Name:FUTURE BRIGHT LIGHT CORP
Entity Type:Organization
Organization Name:FUTURE BRIGHT LIGHT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P
Authorized Official - Prefix:
Authorized Official - First Name:LEONELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-260-3914
Mailing Address - Street 1:4720 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6101
Mailing Address - Country:US
Mailing Address - Phone:561-260-3914
Mailing Address - Fax:
Practice Address - Street 1:4720 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6101
Practice Address - Country:US
Practice Address - Phone:561-260-3914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty