Healthcare Provider Details

I. General information

NPI: 1043817034
Provider Name (Legal Business Name): BRENO WILLIAM LAREDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 EXECUTIVE CENTER DR APT 201
WEST PALM BEACH FL
33401-2966
US

IV. Provider business mailing address

431 EXECUTIVE CENTER DR APT 201
WEST PALM BEACH FL
33401-2966
US

V. Phone/Fax

Practice location:
  • Phone: 561-567-4966
  • Fax:
Mailing address:
  • Phone: 561-567-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: