MEDICARE: ESTEILER CARDONA FUENTES

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1821824707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTEILER CARDONA FUENTES

Provider Business Mailing Address
First Line	:	4235 SW 98TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5156
Country	:	US
Telephone Number	:	305-874-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 SW 98TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5156
Country	:	US
Telephone Number	:	305-874-8013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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Directions to “ ESTEILER CARDONA FUENTES ” Practice Location

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