Healthcare Provider Details

I. General information

NPI: 1710674718
Provider Name (Legal Business Name): JOAQUIN LLANES-ALVAREZ RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SE 23RD AVE
BOYNTON BEACH FL
33435-7620
US

IV. Provider business mailing address

4431 NW 10TH ST
COCONUT CREEK FL
33066-1531
US

V. Phone/Fax

Practice location:
  • Phone: 754-367-6133
  • Fax:
Mailing address:
  • Phone: 754-367-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-267903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: