Healthcare Provider Details

I. General information

NPI: 1407610926
Provider Name (Legal Business Name): DANIELA OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12485 SW 137TH AVE STE 106
MIAMI FL
33186-4215
US

IV. Provider business mailing address

11743 SW 113TH TER
MIAMI FL
33186-3971
US

V. Phone/Fax

Practice location:
  • Phone: 786-250-4423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-314748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: