Provider Demographics
NPI:1578199063
Name:ELGUEZABAL, ANNETTE VICTORIA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:VICTORIA
Last Name:ELGUEZABAL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 PARK CENTRAL DR APT 711
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-5365
Mailing Address - Country:US
Mailing Address - Phone:305-965-6979
Mailing Address - Fax:
Practice Address - Street 1:13538 VILLAGE PARK DR STE 145
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-3600
Practice Address - Country:US
Practice Address - Phone:407-730-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01910171103K00000X
FL0-19-10171106E00000X
106E00000X
FL1-22-62950103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01910171OtherBCABA