Healthcare Provider Details

I. General information

NPI: 1427651082
Provider Name (Legal Business Name): JOSE ANTONIO BOMBALE ROJAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 NE 9TH PL
CAPE CORAL FL
33909-4432
US

IV. Provider business mailing address

2022 NE 9TH PL
CAPE CORAL FL
33909-4432
US

V. Phone/Fax

Practice location:
  • Phone: 239-834-8299
  • Fax:
Mailing address:
  • Phone: 239-834-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89475
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: