Healthcare Provider Details

I. General information

NPI: 1811756836
Provider Name (Legal Business Name): ORLANDO CUEVAS DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 SW 128TH CT
MIAMI FL
33186-4647
US

IV. Provider business mailing address

12150 SW 128TH CT
MIAMI FL
33186-4647
US

V. Phone/Fax

Practice location:
  • Phone: 786-732-0508
  • Fax: 786-842-3815
Mailing address:
  • Phone: 786-732-0508
  • Fax: 786-842-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-320189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: