Healthcare Provider Details

I. General information

NPI: 1043156813
Provider Name (Legal Business Name): DANIELA DE LA CARIDAD MIRABAL GALLOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9860 SW 32ND ST
MIAMI FL
33165-2939
US

IV. Provider business mailing address

9860 SW 32ND ST
MIAMI FL
33165-2939
US

V. Phone/Fax

Practice location:
  • Phone: 786-644-7696
  • Fax:
Mailing address:
  • Phone: 786-644-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-532229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: