Healthcare Provider Details

I. General information

NPI: 1154186567
Provider Name (Legal Business Name): NEILY MARTINEZ CANTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 SW 70TH TER
MIAMI FL
33173-2156
US

IV. Provider business mailing address

11050 SW 70TH TER
MIAMI FL
33173-2156
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-0647
  • Fax:
Mailing address:
  • Phone: 305-204-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90064
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: