Healthcare Provider Details

I. General information

NPI: 1982279824
Provider Name (Legal Business Name): EDITH M OBREGON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 NW 12TH AVE APT 809
MIAMI FL
33128-2208
US

IV. Provider business mailing address

219 NW 12TH AVE APT 809
MIAMI FL
33128-2208
US

V. Phone/Fax

Practice location:
  • Phone: 305-842-7106
  • Fax:
Mailing address:
  • Phone: 305-842-7106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-119161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: