Most Relevant Information
Provider Data
| NPI Number: | 1003422908 |
| Provider Name: | FREDY MANUEL FONSECA AVILA RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-20-118657 |
Most Important Dates
| Enumeration Date: | 09/17/2020 |
| Last Updated: | 09/17/2020 |
Provider Practice Location
8245 NW 36TH ST STE 7
DORAL
FL
331666636
Practice Location Phone/Fax
| Phone: | 3055945658 |
| Fax: |
Provider Mailing Location
2601 NW 16TH STREET RD APT 236
MIAMI
FL
331251482
Provider Mailing Phone/Fax
| Phone: | 7868651297 |
| Fax: |