MEDICARE: JOHNNATAN CARBONELL BUSTAMANTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-472593	FL
2	103K00000X	Behavior Analyst	1-26-88467	FL

General Provider Information

NPI Number	:	1417828476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNATAN CARBONELL BUSTAMANTE

Provider Business Mailing Address
First Line	:	4801 SABLE PINE CIR APT B1
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-3130
Country	:	US
Telephone Number	:	561-817-7264
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 SABLE PINE CIR APT B1
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-3130
Country	:	US
Telephone Number	:	561-817-7264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	03/20/2026

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