Healthcare Provider Details

I. General information

NPI: 1003475468
Provider Name (Legal Business Name): ERNESTO ALEJANDRO CARTA BRIZUELA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 SW 134TH ST STE 201
MIAMI FL
33186-4585
US

IV. Provider business mailing address

8400 SW 14TH ST
MIAMI FL
33144-4129
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-6500
  • Fax:
Mailing address:
  • Phone: 786-375-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-10854
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-55382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: