Provider Demographics
NPI:1447015854
Name:LARROSA NOGUEIRA, ALBERTO
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:LARROSA NOGUEIRA
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 1:3401 SW 9TH TER APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4441
Mailing Address - Country:US
Mailing Address - Phone:786-388-7008
Mailing Address - Fax:
Practice Address - Street 1:701 PROMENADE DR STE 250
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6035
Practice Address - Country:US
Practice Address - Phone:954-399-2637
Practice Address - Fax:954-272-7110
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1022353106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty