Healthcare Provider Details

I. General information

NPI: 1144022807
Provider Name (Legal Business Name): NYLIEM GUZMAN SOTOMAYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NW 174TH ST
MIAMI FL
33169-5203
US

IV. Provider business mailing address

921 NW 174TH ST
MIAMI FL
33169-5203
US

V. Phone/Fax

Practice location:
  • Phone: 645-229-2892
  • Fax:
Mailing address:
  • Phone: 645-229-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-418046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: