Healthcare Provider Details

I. General information

NPI: 1548896822
Provider Name (Legal Business Name): ABA THERAPY CENTERS OF EXCELLENCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEMBROOK DR STE 372
ORLANDO FL
32810-6928
US

IV. Provider business mailing address

1800 PEMBROOK DR STE 372
ORLANDO FL
32810-6928
US

V. Phone/Fax

Practice location:
  • Phone: 407-667-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAULINO AGUILERA
Title or Position: CEO
Credential:
Phone: 407-667-4700