Healthcare Provider Details

I. General information

NPI: 1124784277
Provider Name (Legal Business Name): GRISSEL GUERRERO COSTA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SW 137TH AVE STE 103
MIAMI FL
33186-1435
US

IV. Provider business mailing address

11475 SW 57TH ST
MIAMI FL
33173-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-671-3503
  • Fax: 305-671-3305
Mailing address:
  • Phone: 786-306-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT20125125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: