Provider Demographics
NPI:1255835120
Name:CHAVIANO MALBOA, RONNEY
Entity Type:Individual
Prefix:
First Name:RONNEY
Middle Name:
Last Name:CHAVIANO MALBOA
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 1:3521 SW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4350
Mailing Address - Country:US
Mailing Address - Phone:305-968-8524
Mailing Address - Fax:
Practice Address - Street 1:3521 SW 89TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4350
Practice Address - Country:US
Practice Address - Phone:305-968-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician