Healthcare Provider Details

I. General information

NPI: 1992374102
Provider Name (Legal Business Name): KLBAC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 SAINT THOMAS AVE
KEY LARGO FL
33037-4321
US

IV. Provider business mailing address

263 SAINT THOMAS AVE
KEY LARGO FL
33037-4321
US

V. Phone/Fax

Practice location:
  • Phone: 305-764-2070
  • Fax:
Mailing address:
  • Phone: 305-764-2070
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: LIMAY PEREZ CHAVIANO
Title or Position: BCBA
Credential:
Phone: 305-764-2070