Healthcare Provider Details

I. General information

NPI: 1225932544
Provider Name (Legal Business Name): KEVIN A ORTIZ CANTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18031 NW 47TH CT
MIAMI GARDENS FL
33055-3204
US

IV. Provider business mailing address

18031 NW 47TH CT
MIAMI GARDENS FL
33055-3204
US

V. Phone/Fax

Practice location:
  • Phone: 786-340-4536
  • Fax:
Mailing address:
  • Phone: 786-340-4536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2854025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: