Healthcare Provider Details

I. General information

NPI: 1376357327
Provider Name (Legal Business Name): ECTRIS CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15452 SW 146TH TER
MIAMI FL
33196-4628
US

IV. Provider business mailing address

15452 SW 146TH TER
MIAMI FL
33196-4628
US

V. Phone/Fax

Practice location:
  • Phone: 305-916-9789
  • Fax:
Mailing address:
  • Phone: 305-916-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KATIA E IBARRA SOLLANO
Title or Position: VD
Credential:
Phone: 305-916-9789