Healthcare Provider Details

I. General information

NPI: 1558064709
Provider Name (Legal Business Name): ATIRIS PAMELA CUADRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 SW 123RD CT APT L102
MIAMI FL
33186-4146
US

IV. Provider business mailing address

8820 SW 123RD CT APT L102
MIAMI FL
33186-4146
US

V. Phone/Fax

Practice location:
  • Phone: 305-721-5797
  • Fax:
Mailing address:
  • Phone: 305-721-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-260989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: