Healthcare Provider Details

I. General information

NPI: 1801303698
Provider Name (Legal Business Name): PAMELA GISSELLE CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12485 SW 137TH AVE
MIAMI FL
33186-4216
US

IV. Provider business mailing address

12485 SW 137TH AVE
MIAMI FL
33186-4216
US

V. Phone/Fax

Practice location:
  • Phone: 305-846-9807
  • Fax: 305-846-9711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: