Healthcare Provider Details

I. General information

NPI: 1841153699
Provider Name (Legal Business Name): DAVID VERA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 WELLNESS WAY STE 210
FORT MILL SC
29715-7352
US

IV. Provider business mailing address

16255 VENTURA BLVD STE 900
ENCINO CA
91436-2317
US

V. Phone/Fax

Practice location:
  • Phone: 803-335-0718
  • Fax:
Mailing address:
  • Phone:
  • Fax: 801-316-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-497739
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: