Healthcare Provider Details

I. General information

NPI: 1629681259
Provider Name (Legal Business Name): EDSON MORALES FELIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N COLLIER BLVD
MARCO ISLAND FL
34145-2549
US

IV. Provider business mailing address

1151 N COLLIER BLVD
MARCO ISLAND FL
34145-2549
US

V. Phone/Fax

Practice location:
  • Phone: 305-877-1338
  • Fax:
Mailing address:
  • Phone: 305-877-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-131907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: