Healthcare Provider Details

I. General information

NPI: 1598479727
Provider Name (Legal Business Name): ALEXIS ARDINES BONACHEA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 53RD TER
HIALEAH FL
33013-1457
US

IV. Provider business mailing address

151 E 53RD TER
HIALEAH FL
33013-1457
US

V. Phone/Fax

Practice location:
  • Phone: 786-317-7363
  • Fax:
Mailing address:
  • Phone: 786-317-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCM103830
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBHT.0100373
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-300122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: