Provider Demographics
NPI:1578860623
Name:BOSCH, ALBERTO EDUARDO
Entity Type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:EDUARDO
Last Name:BOSCH
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 1:1 GLEN ROYAL PKWY APT 601
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5288
Mailing Address - Country:US
Mailing Address - Phone:786-439-9934
Mailing Address - Fax:305-982-8579
Practice Address - Street 1:8765 SW 165TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5832
Practice Address - Country:US
Practice Address - Phone:786-577-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2023-08-25
Deactivation Date:2023-07-29
Deactivation Code:
Reactivation Date:2023-08-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist