Healthcare Provider Details

I. General information

NPI: 1215704762
Provider Name (Legal Business Name): RUBEN ALEJANDRO ESQUIVIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 107TH AVE STE 306
SWEETWATER FL
33172-2746
US

IV. Provider business mailing address

6234 SW 139TH CT
MIAMI FL
33183-1909
US

V. Phone/Fax

Practice location:
  • Phone: 787-697-1299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-312557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: