Provider Demographics
NPI:1922528876
Name:AVILA ESTRADA, FABRISIO A (RBT)
Entity Type:Individual
Prefix:MR
First Name:FABRISIO
Middle Name:A
Last Name:AVILA ESTRADA
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 1:909 N MIAMI BEACH BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3712
Mailing Address - Country:US
Mailing Address - Phone:305-822-7202
Mailing Address - Fax:
Practice Address - Street 1:19800 SW 180TH AVE # LOTE504
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-2619
Practice Address - Country:US
Practice Address - Phone:305-646-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-07428106S00000X
FL287665106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty