Provider Demographics
NPI:1578341483
Name:RIBEIRO, FERNANDO DIAS (RBT)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:DIAS
Last Name:RIBEIRO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 RUSSEL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1914
Mailing Address - Country:US
Mailing Address - Phone:925-525-9024
Mailing Address - Fax:
Practice Address - Street 1:4727 W IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5326
Practice Address - Country:US
Practice Address - Phone:407-978-6085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB979922106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician