Healthcare Provider Details

I. General information

NPI: 1013616101
Provider Name (Legal Business Name): DANIELA TIBURCIO RUBIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 NW 4TH TER
MIAMI FL
33125-4053
US

IV. Provider business mailing address

3640 NW 4TH TER
MIAMI FL
33125-4053
US

V. Phone/Fax

Practice location:
  • Phone: 786-222-8512
  • Fax:
Mailing address:
  • Phone: 786-222-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-245103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: