Healthcare Provider Details

I. General information

NPI: 1053278473
Provider Name (Legal Business Name): CARLOS DAVID TAMAYO RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 SW 10TH ST
MIAMI FL
33135-4410
US

IV. Provider business mailing address

3335 SW 10TH ST
MIAMI FL
33135-4410
US

V. Phone/Fax

Practice location:
  • Phone: 925-597-8785
  • Fax:
Mailing address:
  • Phone: 925-597-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: