Healthcare Provider Details

I. General information

NPI: 1821570672
Provider Name (Legal Business Name): KATIUSKA CRUZ AGUILERA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 W FLAGGLER ST SUITE 103
MIAMI FL
33144
US

IV. Provider business mailing address

20950 SW 87TH AVE APT 107
CUTLER BAY FL
33189
US

V. Phone/Fax

Practice location:
  • Phone: 305-909-4872
  • Fax:
Mailing address:
  • Phone: 786-273-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-71644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: