Individual
ALEX DAVID RADE MORENO I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
8359 BEACON BLVD, FORT MYERS, FL 33907-3048
(239) 529-0957
Mailing address
2167 BROOM CT, PORT CHARLOTTE, FL 33952-4601
(502) 434-1082
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
FL
Other
Enumeration date
09/22/2021
Last updated
09/22/2021
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