Healthcare Provider Details

I. General information

NPI: 1306293956
Provider Name (Legal Business Name): OSCAR MONGE GREGORIO BCABA 0-17-7928
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 SW 153RD PL
MIAMI FL
33196-4652
US

IV. Provider business mailing address

14000 SW 153RD PL
MIAMI FL
33196-4652
US

V. Phone/Fax

Practice location:
  • Phone: 786-296-7024
  • Fax:
Mailing address:
  • Phone: 786-296-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0177928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: