Healthcare Provider Details

I. General information

NPI: 1073395984
Provider Name (Legal Business Name): NICHOLAS ALEJANDRO GUARDERAS-VERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6953 UNIVERSITY BLVD
WINTER PARK FL
32792-6710
US

IV. Provider business mailing address

9907 HARTFORD MAROON RD
ORLANDO FL
32827-6911
US

V. Phone/Fax

Practice location:
  • Phone: 407-543-8356
  • Fax:
Mailing address:
  • Phone: 407-233-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-303130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: