Healthcare Provider Details

I. General information

NPI: 1447924048
Provider Name (Legal Business Name): ERNESTO CARDENAS ROVIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22218 SW 58TH AVE
BOCA RATON FL
33428-4532
US

IV. Provider business mailing address

22218 SW 58TH AVE
BOCA RATON FL
33428-4532
US

V. Phone/Fax

Practice location:
  • Phone: 561-306-0313
  • Fax:
Mailing address:
  • Phone: 561-306-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-146516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: