Healthcare Provider Details

I. General information

NPI: 1023993276
Provider Name (Legal Business Name): DAMARIS CISNEROS GRACIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8536 SW 107TH AVE APT B3
MIAMI FL
33173-4437
US

IV. Provider business mailing address

8536 SW 107TH AVE APT B3
MIAMI FL
33173-4437
US

V. Phone/Fax

Practice location:
  • Phone: 832-576-4848
  • Fax:
Mailing address:
  • Phone: 832-576-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-458891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: