Healthcare Provider Details

I. General information

NPI: 1811835010
Provider Name (Legal Business Name): GRICEL SUSANA QUINTERO LICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 8TH ST STE 258
MIAMI FL
33144-4000
US

IV. Provider business mailing address

8615 NW 8TH ST APT 203
MIAMI FL
33126-5922
US

V. Phone/Fax

Practice location:
  • Phone: 305-810-8869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-514398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: