Healthcare Provider Details

I. General information

NPI: 1659724037
Provider Name (Legal Business Name): MABEL CAUSILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24901 SW 134TH CT APT 4
HOMESTEAD FL
33032
US

IV. Provider business mailing address

24901 SW 134TH CT APT 4
HOMESTEAD FL
33032-5675
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-6073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: