Healthcare Provider Details

I. General information

NPI: 1265104236
Provider Name (Legal Business Name): ABELARDO CUZA MATIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 05/20/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9863 LIBERTY RD
BOCA RATON FL
33434-2385
US

IV. Provider business mailing address

9863 LIBERTY RD
BOCA RATON FL
33434-2385
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-8463
  • Fax:
Mailing address:
  • Phone: 561-674-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: