Healthcare Provider Details

I. General information

NPI: 1659841252
Provider Name (Legal Business Name): NATACHA CUERVO BETANCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 10/29/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SW 106TH AVE
MIAMI FL
33165-3627
US

IV. Provider business mailing address

3600 SW 106TH AVE
MIAMI FL
33165-3627
US

V. Phone/Fax

Practice location:
  • Phone: 786-557-0986
  • Fax:
Mailing address:
  • Phone: 786-557-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62078
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-72788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: