MEDICARE: CARLOS MANUEL CHICA

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
2	103K00000X	Behavior Analyst		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669988838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MANUEL CHICA

Provider Business Mailing Address
First Line	:	124 SW 31ST ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4555
Country	:	US
Telephone Number	:	305-917-5901
Fax Number	:

Provider Business Practice Location Address
First Line	:	6844 INTERNATIONAL CENTER BLVD STE 500
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7159
Country	:	US
Telephone Number	:	417-860-7640
Fax Number	:

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

Provider Enumeration Date	:	12/23/2017
Last Update Date	:	02/01/2021

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Directions to “ CARLOS MANUEL CHICA ” Practice Location

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