Healthcare Provider Details

I. General information

NPI: 1023532256
Provider Name (Legal Business Name): KAYLA DUSTMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2017
Last Update Date: 03/03/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-1818
  • Fax: 888-512-0733
Mailing address:
  • Phone: 844-244-1818
  • Fax: 888-512-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63929
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-37795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: