Healthcare Provider Details

I. General information

NPI: 1316708969
Provider Name (Legal Business Name): LUIS A QUERZOLA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 COLONIAL BLVD STE 2
FORT MYERS FL
33966-1062
US

IV. Provider business mailing address

311 SW 19TH LN
CAPE CORAL FL
33991-3784
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-3715
  • Fax:
Mailing address:
  • Phone: 551-455-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-268357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: