Healthcare Provider Details

I. General information

NPI: 1306397187
Provider Name (Legal Business Name): MICHAEL OVAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date: 07/01/2019
Reactivation Date: 07/05/2019

III. Provider practice location address

1239 E NEWPORT CENTER DR #101
DEERFIELD BEACH FL
33442
US

IV. Provider business mailing address

1239 E NEWPORT CENTER DR #101
DEERFIELD BEACH FL
33442
US

V. Phone/Fax

Practice location:
  • Phone: 754-443-3707
  • Fax:
Mailing address:
  • Phone: 754-443-3707
  • 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 Number1-19-36663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: