Healthcare Provider Details

I. General information

NPI: 1568078574
Provider Name (Legal Business Name): ANDY ARTILES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST STE 203
MIAMI FL
33125-4141
US

IV. Provider business mailing address

16621 SW 44TH LN
MIAMI FL
33185-3898
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax: 866-726-0526
Mailing address:
  • Phone: 786-447-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: