MEDICARE: CORNERSTONE BEHAVIORAL ANALYSIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1093360398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE BEHAVIORAL ANALYSIS

Provider Business Mailing Address
First Line	:	12920 SW 133RD CT UNIT 11
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6149
Country	:	US
Telephone Number	:	786-475-5732
Fax Number	:	844-455-3224

Provider Business Practice Location Address
First Line	:	12920 SW 133RD CT UNIT 11
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6149
Country	:	US
Telephone Number	:	786-475-5732
Fax Number	:	844-455-3224

Authorized Official
Title or Position	:	CO-OWNER
Name	:	EIMI MEJIA TRUJILLO
Credential	:	BCBA
Telephone Number	:	786-475-5732

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	10/01/2024

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