Healthcare Provider Details

I. General information

NPI: 1730016858
Provider Name (Legal Business Name): CORALIA DEL CARMEN AMADOR OBANDO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 NW 186TH ST
MIAMI GARDENS FL
33055-2557
US

IV. Provider business mailing address

4820 NW 186TH ST
MIAMI GARDENS FL
33055-2557
US

V. Phone/Fax

Practice location:
  • Phone: 786-805-8786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-524195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: