Healthcare Provider Details

I. General information

NPI: 1013504901
Provider Name (Legal Business Name): RAIZA CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18928 NW 46TH AVE
MIAMI GARDENS FL
33055-2651
US

IV. Provider business mailing address

18928 NW 46TH AVE
MIAMI GARDENS FL
33055-2651
US

V. Phone/Fax

Practice location:
  • Phone: 502-202-7216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-7873-211312
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-116920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: