Healthcare Provider Details

I. General information

NPI: 1952272619
Provider Name (Legal Business Name): CHEILA CUERVO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NW 187TH DR
MIAMI FL
33169-3845
US

IV. Provider business mailing address

760 NW 187TH DR
MIAMI FL
33169-3845
US

V. Phone/Fax

Practice location:
  • Phone: 786-322-0986
  • Fax:
Mailing address:
  • Phone: 786-322-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-465941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: