Healthcare Provider Details

I. General information

NPI: 1982487518
Provider Name (Legal Business Name): SANDRA FUENTES MONZON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13251 SW 17TH LN APT 4
MIAMI FL
33175-7608
US

IV. Provider business mailing address

13251 SW 17TH LN APT 4
MIAMI FL
33175-7608
US

V. Phone/Fax

Practice location:
  • Phone: 305-699-1298
  • Fax:
Mailing address:
  • Phone: 305-699-1298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBCABA-0-25-16227
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-290660
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: