Healthcare Provider Details

I. General information

NPI: 1164504643
Provider Name (Legal Business Name): LUIS BRETONES SR. SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

145 WATERWAY RD
ROYAL PALM BEACH FL
33411-1554
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-9101
  • Fax:
Mailing address:
  • Phone: 305-767-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56731
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI 1202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: