Healthcare Provider Details

I. General information

NPI: 1073170288
Provider Name (Legal Business Name): AGATHA C CUADRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 SW 2ND CT
HOMESTEAD FL
33030-6675
US

IV. Provider business mailing address

997 NW 106TH AVENUE CIR
MIAMI FL
33172-3122
US

V. Phone/Fax

Practice location:
  • Phone: 786-387-2705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: