MEDICARE: FABIOLA RODRIGUEZ COLLAZO BCBA

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	106E00000X	Assistant Behavior Analyst	0-21-12686
2	106S00000X	Behavior Technician	RBT-20-122366
3	103K00000X	Behavior Analyst	1-25-84219	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	:	1831716836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIOLA RODRIGUEZ COLLAZO BCBA

Provider Business Mailing Address
First Line	:	5449 PECAN DR
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-3178
Country	:	US
Telephone Number	:	754-703-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-4228
Country	:	US
Telephone Number	:	754-703-0164
Fax Number	:

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

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	09/23/2025

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