Provider Demographics
NPI:1366297863
Name:ALONSO ESPINOSA, GENER (RBT)
Entity type:Individual
Prefix:
First Name:GENER
Middle Name:
Last Name:ALONSO ESPINOSA
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 1:5308 SW 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4353
Mailing Address - Country:US
Mailing Address - Phone:954-859-7784
Mailing Address - Fax:
Practice Address - Street 1:5308 SW 86TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-4353
Practice Address - Country:US
Practice Address - Phone:954-859-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-328001106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician