Provider Demographics
NPI:1760950216
Name:APONTE, SERGIO GABRIEL
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:GABRIEL
Last Name:APONTE
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 1:5251 MILL STREAM DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8711
Mailing Address - Country:US
Mailing Address - Phone:407-308-4602
Mailing Address - Fax:407-483-9551
Practice Address - Street 1:5251 MILL STREAM DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8711
Practice Address - Country:US
Practice Address - Phone:407-308-4602
Practice Address - Fax:407-483-9551
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-17-31620OtherBEHAVIOR ANALISYS CERTIFICATION BOARD
FL020259700Medicaid