Provider Demographics
NPI:1982338620
Name:SIMOZA, REMIGIO AUGUSTO
Entity Type:Individual
Prefix:
First Name:REMIGIO
Middle Name:AUGUSTO
Last Name:SIMOZA
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 1:3621 OLEANDER TER
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1876
Mailing Address - Country:US
Mailing Address - Phone:561-201-1026
Mailing Address - Fax:
Practice Address - Street 1:2151 CONSULATE DR STE 11
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8806
Practice Address - Country:US
Practice Address - Phone:321-444-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22223557106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician