Healthcare Provider Details

I. General information

NPI: 1073443941
Provider Name (Legal Business Name): MAURICIO MILLA VALDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28118 ARROWHEAD CIR
PUNTA GORDA FL
33982-4807
US

IV. Provider business mailing address

28118 ARROWHEAD CIR
PUNTA GORDA FL
33982-4807
US

V. Phone/Fax

Practice location:
  • Phone: 239-344-9236
  • Fax: 239-790-1408
Mailing address:
  • Phone: 239-344-9236
  • Fax: 239-790-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-497408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: