Healthcare Provider Details

I. General information

NPI: 1902772692
Provider Name (Legal Business Name): CARLOS CAZORLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3963 26TH AVE SE
NAPLES FL
34117-8869
US

IV. Provider business mailing address

3963 26TH AVE SE
NAPLES FL
34117-8869
US

V. Phone/Fax

Practice location:
  • Phone: 239-601-8269
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: