Provider Demographics
NPI:1740097062
Name:HIDALGO GATO BORROTO, OCNAY
Entity type:Individual
Prefix:
First Name:OCNAY
Middle Name:
Last Name:HIDALGO GATO BORROTO
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 1:3301 SW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2025
Mailing Address - Country:US
Mailing Address - Phone:954-802-8299
Mailing Address - Fax:
Practice Address - Street 1:3301 SW 50TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-2025
Practice Address - Country:US
Practice Address - Phone:954-802-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24397445106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician