=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720586027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TORTU, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2018
-----------------------------------------------------
Last Update Date | 07/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 BRICKELL AVE APT B1001
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33129-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-281-7294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 BRICKELL AVE APT B1001
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33129-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-281-7294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FLORENCIA DECASTELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-281-7294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------