Healthcare Provider Details

I. General information

NPI: 1730003955
Provider Name (Legal Business Name): SOL A CRISANTO-OJEDA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 SW 36TH ST STE 9
DAVIE FL
33328-1915
US

IV. Provider business mailing address

2239 NW 82ND AVE
SUNRISE FL
33322-3011
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax:
Mailing address:
  • Phone: 954-235-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: