Healthcare Provider Details

I. General information

NPI: 1790565646
Provider Name (Legal Business Name): ARC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 W 20TH AVE STE C
HIALEAH FL
33016-2604
US

IV. Provider business mailing address

12351 SW 256TH ST
HOMESTEAD FL
33032-7048
US

V. Phone/Fax

Practice location:
  • Phone: 561-379-4625
  • Fax:
Mailing address:
  • Phone: 561-379-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AYSBELL ROZOS COSTALES
Title or Position: MGR
Credential:
Phone: 561-379-4625