Provider Demographics
NPI:1467224840
Name:IBARRA PRADO, ROBERTO JAVIER (RBT-23-304399)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:JAVIER
Last Name:IBARRA PRADO
Suffix:
Gender:M
Credentials:RBT-23-304399
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1251
Mailing Address - Country:US
Mailing Address - Phone:239-628-0473
Mailing Address - Fax:
Practice Address - Street 1:314 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1251
Practice Address - Country:US
Practice Address - Phone:239-628-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-304399106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician