Healthcare Provider Details

I. General information

NPI: 1730846395
Provider Name (Legal Business Name): MS. MAIDE ALFONSO REMEDIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21735 SW 104TH CT APT 101
CUTLER BAY FL
33190-1054
US

IV. Provider business mailing address

21735 SW 104TH CT APT 101
CUTLER BAY FL
33190-1054
US

V. Phone/Fax

Practice location:
  • Phone: 786-597-1938
  • Fax:
Mailing address:
  • Phone: 786-597-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-193454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: