Provider Demographics
NPI:1851156657
Name:PARDO, ROYLAN
Entity Type:Individual
Prefix:
First Name:ROYLAN
Middle Name:
Last Name:PARDO
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 1:9923 W OKEECHOBEE RD APT 319A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2151
Mailing Address - Country:US
Mailing Address - Phone:786-658-2206
Mailing Address - Fax:
Practice Address - Street 1:9923 W OKEECHOBEE RD APT 319A
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2151
Practice Address - Country:US
Practice Address - Phone:786-658-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-317971106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician