Provider Demographics
NPI:1366048795
Name:TABOADA, ADRIAN A
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:A
Last Name:TABOADA
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 1:1913 SW 107TH AVE APT 1102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7349
Mailing Address - Country:US
Mailing Address - Phone:786-619-5620
Mailing Address - Fax:
Practice Address - Street 1:1913 SW 107TH AVE APT 1102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7349
Practice Address - Country:US
Practice Address - Phone:786-619-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician