Healthcare Provider Details

I. General information

NPI: 1235685322
Provider Name (Legal Business Name): CARLOS RAFAEL MACHADO COLON BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 04/13/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12953 DOWNSTREAM CIR
ORLANDO FL
32828-9148
US

IV. Provider business mailing address

12953 DOWNSTREAM CIR
ORLANDO FL
32828-9148
US

V. Phone/Fax

Practice location:
  • Phone: 321-616-9794
  • Fax: 321-241-1171
Mailing address:
  • Phone: 321-616-9794
  • Fax: 321-241-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: