Healthcare Provider Details

I. General information

NPI: 1346706033
Provider Name (Legal Business Name): CHRISTOPHER MENA-GIBSON MA, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 10/01/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12448 SW 127TH AVE FL 2
MIAMI FL
33186-6596
US

IV. Provider business mailing address

15431 SW 47TH ST
MIAMI FL
33185-4493
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-8500
  • Fax:
Mailing address:
  • Phone: 786-202-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: