Healthcare Provider Details

I. General information

NPI: 1144813114
Provider Name (Legal Business Name): ABA BEHAVIORAL ADVANCEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 SANDS HARBOR TRCE
POMPANO BEACH FL
33069-6121
US

IV. Provider business mailing address

3433 SANDS HARBOR TRCE
POMPANO BEACH FL
33069-6121
US

V. Phone/Fax

Practice location:
  • Phone: 786-391-6772
  • Fax: 954-544-4992
Mailing address:
  • Phone: 786-391-6772
  • Fax: 954-544-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: OTANYS GARCIA
Title or Position: OWNER
Credential: ABA
Phone: 786-391-6772