Healthcare Provider Details

I. General information

NPI: 1023890001
Provider Name (Legal Business Name): FERNANDO ZALDIVAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 203
DAVIE FL
33328-5309
US

IV. Provider business mailing address

6971 N FEDERAL HWY STE 206
BOCA RATON FL
33487-1648
US

V. Phone/Fax

Practice location:
  • Phone: 954-513-9545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: