Healthcare Provider Details

I. General information

NPI: 1497669642
Provider Name (Legal Business Name): ESTEBAN CABASSA MISKIMEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2543 ROSS CLARK CIR
DOTHAN AL
36301-4925
US

IV. Provider business mailing address

2543 ROSS CLARK CIR
DOTHAN AL
36301-4925
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-4007
  • Fax:
Mailing address:
  • Phone: 334-699-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2025-134
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: