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General NPI Number Information
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NPI Number | 1407380199
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Entity Type | Individual
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Provider Name | WALDO C NORSTAD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 05/27/2018
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Provider Practice Location Address
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Address Line | 911 SW 43RD AVE
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City | MIAMI
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-300-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 HERITAGE CIR APT 102
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City | NAPLES
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State | FL
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Zip | 34116-3006
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Country | US
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Telephone | 305-300-4677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT1853140
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA341021
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License Number State | FL
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