Healthcare Provider Details

I. General information

NPI: 1508760372
Provider Name (Legal Business Name): MAIKOL JESUS CINTRA GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10674 SW 186TH ST
CUTLER BAY FL
33157-6720
US

IV. Provider business mailing address

10674 SW 186TH ST
CUTLER BAY FL
33157-6720
US

V. Phone/Fax

Practice location:
  • Phone: 786-713-0892
  • Fax: 786-524-2783
Mailing address:
  • Phone: 786-713-0892
  • Fax: 786-524-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2857396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: