Healthcare Provider Details

I. General information

NPI: 1235919549
Provider Name (Legal Business Name): YANIEL CANTILLO RBT, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 202
DORAL FL
33166-6652
US

IV. Provider business mailing address

1860 CORAL WAY APT 1
MIAMI FL
33145-2746
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-8845
  • Fax: 888-206-1341
Mailing address:
  • Phone: 786-988-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23300836
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: