Healthcare Provider Details

I. General information

NPI: 1861262396
Provider Name (Legal Business Name): YUNIOR F MEDEROS FUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 MARTINIQUE DR
CUTLER BAY FL
33189-1746
US

IV. Provider business mailing address

10250 MARTINIQUE DR
CUTLER BAY FL
33189-1746
US

V. Phone/Fax

Practice location:
  • Phone: 786-656-3435
  • Fax:
Mailing address:
  • Phone: 786-656-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15713
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-368264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: