Healthcare Provider Details

I. General information

NPI: 1669055596
Provider Name (Legal Business Name): MARTHA CUERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 NW 129TH ST
NORTH MIAMI FL
33168-3741
US

IV. Provider business mailing address

480 NW 129TH ST
NORTH MIAMI FL
33168-3741
US

V. Phone/Fax

Practice location:
  • Phone: 786-488-0765
  • Fax:
Mailing address:
  • Phone: 786-488-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB540609
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-126627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: