Active NPI
Fredy Manuel Fonseca Avila Sr., RBT
- Behavior Technician
- Doral, FL
National Provider Identifier
1003422908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-118657
- Practice address
- 8245 NW 36TH St Ste 7
Doral, FL 33166-6636 - Phone
- (305) 594-5658
- NPI assigned
- Sep 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-20-118657 | FL | Primary |
Addresses
Primary practice location
8245 NW 36TH St Ste 7
Doral, FL 33166-6636
Mailing address
2601 NW 16TH Street Rd Apt 236
Miami, FL 33125-1482
Phone (786) 865-1297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-118657 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600300800000",
"number": "1003422908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 NW 16TH STREET RD APT 236",
"city": "MIAMI",
"state": "FL",
"postal_code": "331251482",
"telephone_number": "786-865-1297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8245 NW 36TH ST STE 7",
"city": "DORAL",
"state": "FL",
"postal_code": "331666636",
"telephone_number": "305-594-5658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONSECA AVILA",
"first_name": "FREDY",
"middle_name": "MANUEL",
"name_suffix": "Sr.",
"credential": "RBT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-17",
"last_updated": "2020-09-17",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-20-118657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Doral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.