Individual provider Active NPI

Cesar Miguel Fundora, BCBA

  • Behavior Analyst
  • Coconut Creek, FL
National Provider Identifier
1407519424
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-25-82853 Issued in FL
Practice address
4855 W Hillsboro Blvd Ste B12
Coconut Creek, FL 33073-4365
Phone
(754) 399-8507
NPI assigned
Oct 17, 2021
Last updated
Jul 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-25-82853 FL Primary
Assistant Behavior Analyst 106E00000X 0-24-15159 FL

Addresses

Primary practice location

4855 W Hillsboro Blvd Ste B12
Coconut Creek, FL 33073-4365

Mailing address

11612 SW 13TH LN
Pembroke Pines, FL 33025-4824
Phone (786) 402-9619

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

Practice roles

OrganizationSpecialtyStatusNew patients
Creative Minds ABA Services Inc Behavior Analyst CurrentSince Nov 9, 2025 Accepting new patients
Baylight Behavioral Health LLC Behavior Analyst CurrentSince Sep 28, 2025 Accepting new patients

Locations

4855 W Hillsboro Blvd
Ste B12
Coconut Creek, FL 33073
Phone (754) 399-8507

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1407519424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11612 SW 13TH LN",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330254824",
            "telephone_number": "786-402-9619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 W HILLSBORO BLVD STE B12",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734365",
            "telephone_number": "754-399-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDORA",
        "first_name": "CESAR",
        "middle_name": "MIGUEL",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-17",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-25-82853",
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "FL",
            "license": "0-24-15159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coconut Creek, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.