Healthcare Provider Details

I. General information

NPI: 1609550490
Provider Name (Legal Business Name): CARLOS J CACHALDORA GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34984-5108
US

IV. Provider business mailing address

810 SW COMMONWEALTH RD
PORT SAINT LUCIE FL
34953-2349
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-0173
  • Fax:
Mailing address:
  • Phone: 561-313-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-277224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: