Healthcare Provider Details

I. General information

NPI: 1497485940
Provider Name (Legal Business Name): AMBICO BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 RIDGELAND DR
CUTLER BAY FL
33157-7135
US

IV. Provider business mailing address

8881 RIDGELAND DR
CUTLER BAY FL
33157-7135
US

V. Phone/Fax

Practice location:
  • Phone: 786-245-5727
  • Fax:
Mailing address:
  • Phone: 786-245-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA LOPEZ
Title or Position: FOUNDER
Credential:
Phone: 786-245-5727