Healthcare Provider Details

I. General information

NPI: 1063192573
Provider Name (Legal Business Name): LETICIA I CARMONA NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 SW 72ND ST STE B224
MIAMI FL
33173-5460
US

IV. Provider business mailing address

1700 SW 76TH CT
MIAMI FL
33155-1572
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2593
  • Fax: 786-558-4097
Mailing address:
  • Phone: 786-820-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-283463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: