| Fiesta Health Llc | |
|
800 E 70th St Savannah GA 31405-4813 | |
| (912) 214-3314 | |
| (912) 722-4061 |
| Full Name | Fiesta Health Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 800 E 70th St, Savannah, Georgia |
| Authorized Official Name and Position | Jordan P Boudreau (OWNER/CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 2314970555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fiesta Health Llc 634 Holgate Ave Defiance OH 43512-2038 Ph: (912) 491-2491 | Fiesta Health Llc 800 E 70th St Savannah GA 31405-4813 Ph: (912) 214-3314 |
| NPI Number | 1831827724 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 09/20/2024 |
| Certification Date | 09/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831827724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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