Healthcare Provider Details

I. General information

NPI: 1912660580
Provider Name (Legal Business Name): KATHERINE MEDEROS PALMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17510 NW 46TH AVE
MIAMI GARDENS FL
33055-3724
US

IV. Provider business mailing address

17510 NW 46TH AVE
MIAMI GARDENS FL
33055-3724
US

V. Phone/Fax

Practice location:
  • Phone: 786-641-1329
  • Fax:
Mailing address:
  • Phone: 786-641-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number110749900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: