=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164300315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAWELL COSSIO DEL SOLAR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 VILLAGE BLVD APT 917
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-2765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-943-9251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 VILLAGE BLVD APT 917
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-2765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-943-9251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | RBT-25-466305
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------