Healthcare Provider Details

I. General information

NPI: 1326977786
Provider Name (Legal Business Name): GIULIANA ANDREINA CHACON CORALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8774 NW 98TH AVE
DORAL FL
33178-2583
US

IV. Provider business mailing address

8774 NW 98TH AVE
DORAL FL
33178-2583
US

V. Phone/Fax

Practice location:
  • Phone: 786-381-5595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-442633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: