Healthcare Provider Details

I. General information

NPI: 1477231934
Provider Name (Legal Business Name): ALEX M FUENTES JUNQUERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 S MILITARY TRL STE 7
WEST PALM BEACH FL
33415-9141
US

IV. Provider business mailing address

1696 S MILITARY TRL STE C
WEST PALM BEACH FL
33415-5625
US

V. Phone/Fax

Practice location:
  • Phone: 561-323-2552
  • Fax:
Mailing address:
  • Phone: 561-284-6534
  • Fax: 561-584-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2846581
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-280937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: