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General NPI Number Information
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NPI Number | 1316877855
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Entity Type | Organization
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Legal Business Name | ILACUS LLC
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Dates
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Enumeration Date | 05/19/2026
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Last Update Date | 05/21/2026
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Provider Practice Location Address
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Address Line | 10207 N VALLE DR
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City | TAMPA
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State | FL
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Zip | 33612-6570
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Country | US
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Telephone | 813-858-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 10207 N VALLE DR
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City | TAMPA
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State | FL
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Zip | 33612-6570
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Country | US
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Telephone | 813-858-4140
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. RAUL ANDRES NICOLAS BOSCH
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Credential |
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Telephone | 608-520-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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