Healthcare Provider Details

I. General information

NPI: 1467397497
Provider Name (Legal Business Name): AIVLIS ORELLANA TEJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 SILVER FERN WAY
RIVERVIEW FL
33569-2225
US

IV. Provider business mailing address

11116 SILVER FERN WAY
RIVERVIEW FL
33569-2225
US

V. Phone/Fax

Practice location:
  • Phone: 786-616-6408
  • Fax:
Mailing address:
  • Phone: 786-616-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-531000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: