Provider Demographics
NPI:1851164610
Name:BUSOT, ALEC GOBERNA
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:GOBERNA
Last Name:BUSOT
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 1:4832 NW 171ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4260
Mailing Address - Country:US
Mailing Address - Phone:305-301-0675
Mailing Address - Fax:561-516-8183
Practice Address - Street 1:4801 S UNIVERSITY DR STE 130
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3832
Practice Address - Country:US
Practice Address - Phone:954-592-8659
Practice Address - Fax:561-516-8183
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-302477106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician