Healthcare Provider Details

I. General information

NPI: 1124759097
Provider Name (Legal Business Name): RAMON ARELLANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CAPTIVA CIR
KISSIMMEE FL
34741-4115
US

IV. Provider business mailing address

620 CAPTIVA CIR
KISSIMMEE FL
34741-4115
US

V. Phone/Fax

Practice location:
  • Phone: 407-409-6968
  • Fax:
Mailing address:
  • Phone: 407-409-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17045
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number22-230764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: