Healthcare Provider Details

I. General information

NPI: 1720773542
Provider Name (Legal Business Name): AMNELIESES VALDES SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20760 SW 86TH PL
CUTLER BAY FL
33189-3839
US

IV. Provider business mailing address

20760 SW 86TH PL
CUTLER BAY FL
33189-3839
US

V. Phone/Fax

Practice location:
  • Phone: 786-307-9767
  • Fax:
Mailing address:
  • Phone: 786-307-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-142378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: