Healthcare Provider Details

I. General information

NPI: 1023701604
Provider Name (Legal Business Name): ANA RAQUEL BOTELLO FROMETA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6841 W 2ND CT
HIALEAH FL
33014-5301
US

IV. Provider business mailing address

6841 W 2ND CT
HIALEAH FL
33014-5301
US

V. Phone/Fax

Practice location:
  • Phone: 786-407-8853
  • Fax:
Mailing address:
  • Phone: 786-407-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-269410
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-26-2851773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: