Healthcare Provider Details

I. General information

NPI: 1699550327
Provider Name (Legal Business Name): KOALA ABA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 NW 79TH AVE
DORAL FL
33122-1033
US

IV. Provider business mailing address

2898 NW 79TH AVE
DORAL FL
33122-1033
US

V. Phone/Fax

Practice location:
  • Phone: 786-646-9250
  • Fax: 305-597-3863
Mailing address:
  • Phone: 786-646-9250
  • Fax: 305-597-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CARIDAD BOUZA MERIDA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 786-646-9250