Provider Demographics
NPI:1497446561
Name:OLIVA BUSOT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OLIVA BUSOT
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 1:2655 N OCEAN DR STE 305
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4751
Mailing Address - Country:US
Mailing Address - Phone:954-592-8659
Mailing Address - Fax:
Practice Address - Street 1:2655 N OCEAN DR STE 305
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4751
Practice Address - Country:US
Practice Address - Phone:954-592-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23268565106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician