Provider Demographics
NPI:1538527270
Name:MUNOZ, PABLO
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W ATLANTIC BLVD
Mailing Address - Street 2:STE #4
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4532
Mailing Address - Country:US
Mailing Address - Phone:786-351-8410
Mailing Address - Fax:
Practice Address - Street 1:6450 W ATLANTIC BLVD
Practice Address - Street 2:STE #4
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4532
Practice Address - Country:US
Practice Address - Phone:786-351-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-1542247200000X
FL234195372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-16-15492OtherREGISTERED BEHAVIOR TECHNICIAN