Healthcare Provider Details

I. General information

NPI: 1730890799
Provider Name (Legal Business Name): GRACE DE LAS MERCEDES SUBIADUR LA FE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10772 SW 165TH TER
MIAMI FL
33157-2941
US

IV. Provider business mailing address

10772 SW 165TH TER
MIAMI FL
33157-2941
US

V. Phone/Fax

Practice location:
  • Phone: 941-518-8483
  • Fax:
Mailing address:
  • Phone: 941-518-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA799397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: