Healthcare Provider Details

I. General information

NPI: 1659883577
Provider Name (Legal Business Name): MIRNA CAROLINA PACHECO CACERES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 NW 173RD DR UNIT 11
HIALEAH FL
33015-5122
US

IV. Provider business mailing address

50 W 31ST ST APT 101
HIALEAH FL
33012-5463
US

V. Phone/Fax

Practice location:
  • Phone: 786-803-0112
  • Fax:
Mailing address:
  • Phone: 786-803-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: