Healthcare Provider Details

I. General information

NPI: 1689599441
Provider Name (Legal Business Name): CARLOS DAVID AVALOS PORTAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SE 6TH TER
CAPE CORAL FL
33990-1171
US

IV. Provider business mailing address

720 SE 6TH TER
CAPE CORAL FL
33990-1171
US

V. Phone/Fax

Practice location:
  • Phone: 786-491-8497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2835768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: