Healthcare Provider Details

I. General information

NPI: 1366811770
Provider Name (Legal Business Name): BARRY ALOUIDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N
JACKSONVILLE FL
32216-8043
US

IV. Provider business mailing address

6867 SOUTHPOINT DR N
JACKSONVILLE FL
32216-8043
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax: 904-212-0309
Mailing address:
  • Phone: 904-619-6071
  • Fax: 904-212-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: