Healthcare Provider Details

I. General information

NPI: 1992327340
Provider Name (Legal Business Name): AHMED URBIZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17911 SW 152ND CT
MIAMI FL
33187-7770
US

IV. Provider business mailing address

17911 SW 152ND CT
MIAMI FL
33187-7770
US

V. Phone/Fax

Practice location:
  • Phone: 786-290-7320
  • Fax:
Mailing address:
  • Phone: 786-290-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-2011967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: