Healthcare Provider Details

I. General information

NPI: 1053037960
Provider Name (Legal Business Name): ODEYMIS CALDERIN MEDINA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 4TH ST APT 2
HIALEAH FL
33010-4751
US

IV. Provider business mailing address

50 W 4TH ST APT 2
HIALEAH FL
33010-4751
US

V. Phone/Fax

Practice location:
  • Phone: 786-320-4501
  • Fax:
Mailing address:
  • Phone: 786-320-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: