Healthcare Provider Details

I. General information

NPI: 1104670942
Provider Name (Legal Business Name): ZITO CHANGE LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 09/19/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NW 5 TH TER
CAPE CORAL FL
33993
US

IV. Provider business mailing address

25 NW 5 TH TER
CAPE CORAL FL
33993
US

V. Phone/Fax

Practice location:
  • Phone: 786-792-2373
  • Fax:
Mailing address:
  • Phone: 786-792-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ZOE E MARTINEZ ZITO
Title or Position: DIRECTOR
Credential: BCBA
Phone: 786-792-2373