Provider Demographics
NPI:1235685322
Name:MACHADO COLON, CARLOS RAFAEL (BCABA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:MACHADO COLON
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12953 DOWNSTREAM CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9148
Mailing Address - Country:US
Mailing Address - Phone:321-616-9794
Mailing Address - Fax:321-241-1171
Practice Address - Street 1:12953 DOWNSTREAM CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9148
Practice Address - Country:US
Practice Address - Phone:321-616-9794
Practice Address - Fax:321-241-1171
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019248800Medicaid