Healthcare Provider Details

I. General information

NPI: 1811808108
Provider Name (Legal Business Name): ROBERTO HEREDIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10447 SW 108TH AVE
MIAMI FL
33176-8159
US

IV. Provider business mailing address

10447 SW 108TH AVE APT E278
MIAMI FL
33176-8115
US

V. Phone/Fax

Practice location:
  • Phone: 786-645-9900
  • Fax: 305-402-3829
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: