Healthcare Provider Details

I. General information

NPI: 1811677057
Provider Name (Legal Business Name): AVIETA SANTANA TABARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NW 45TH AVE APT 216
MIAMI FL
33126-2406
US

IV. Provider business mailing address

1020 NW 45TH AVE APT 216
MIAMI FL
33126-2406
US

V. Phone/Fax

Practice location:
  • Phone: 786-782-2927
  • Fax:
Mailing address:
  • Phone: 786-782-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBCABA-0-26-2827250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: