Healthcare Provider Details

I. General information

NPI: 1316598402
Provider Name (Legal Business Name): DAYANA BUELGA CARLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SW 33RD AVE
MIAMI FL
33135-2611
US

IV. Provider business mailing address

712 SW 33RD AVE
MIAMI FL
33135-2611
US

V. Phone/Fax

Practice location:
  • Phone: 786-609-2122
  • Fax:
Mailing address:
  • Phone: 786-609-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-96805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: