Search › Florida › 106S00000X
Keanu Boullon
NPI 1144105982 · on the registry since 2025 · sole proprietor
Practice
- Address
- 12505 Sw 28th St
Miami, FL 33175 - Phone
- (786) 770-5813
Registry record
- Primary taxonomy
- 106S00000X
106S00000X
- Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-08-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida