Healthcare Provider Details

I. General information

NPI: 1093555757
Provider Name (Legal Business Name): C.D.A. SERVICEABILITY TRUST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11025 SW 84TH ST STE 9
MIAMI FL
33173-3856
US

IV. Provider business mailing address

9290 SW 66TH ST
MIAMI FL
33173-2310
US

V. Phone/Fax

Practice location:
  • Phone: 305-971-1230
  • Fax:
Mailing address:
  • Phone: 786-395-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISSA TORRES
Title or Position: CEO
Credential:
Phone: 786-395-4900