Healthcare Provider Details

I. General information

NPI: 1396425492
Provider Name (Legal Business Name): ERNESTO ALEJANDRO MARRERO TOLEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 SW VILLAGE PKWY # 19-207
PORT SAINT LUCIE FL
34987-2663
US

IV. Provider business mailing address

11455 SW VILLAGE PKWY # 19-207
PORT SAINT LUCIE FL
34987-2663
US

V. Phone/Fax

Practice location:
  • Phone: 786-820-1069
  • Fax:
Mailing address:
  • Phone: 786-820-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2852476
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-283283
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: