Healthcare Provider Details

I. General information

NPI: 1396626578
Provider Name (Legal Business Name): EGAR BUENO FERNANDEZ I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 DEANNA DR
APOPKA FL
32703-4732
US

IV. Provider business mailing address

2122 DEANNA DR
APOPKA FL
32703-4732
US

V. Phone/Fax

Practice location:
  • Phone: 210-430-7737
  • Fax:
Mailing address:
  • Phone: 210-430-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-472085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: