Healthcare Provider Details

I. General information

NPI: 1922709187
Provider Name (Legal Business Name): GERALDINE MARQUEZ CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2882 BARD ST
PALM SPRINGS FL
33406-3600
US

IV. Provider business mailing address

2882 BARD ST
PALM SPRINGS FL
33406-3600
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-1413
  • Fax:
Mailing address:
  • Phone: 561-704-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-89155
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-261920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: