Healthcare Provider Details

I. General information

NPI: 1447012851
Provider Name (Legal Business Name): MARIA D DAOSTA BEHAVIOR TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21011 NE 25TH CT
MIAMI FL
33180-1033
US

IV. Provider business mailing address

20379 W COUNTRY CLUB DR APT 835
AVENTURA FL
33180-1628
US

V. Phone/Fax

Practice location:
  • Phone: 305-988-5115
  • Fax:
Mailing address:
  • Phone: 305-903-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-322771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: