Healthcare Provider Details

I. General information

NPI: 1356186746
Provider Name (Legal Business Name): MICHEL CUELLAR PAEZ RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 NW 36TH ST STE 100
VIRGINIA GARDENS FL
33166-6977
US

IV. Provider business mailing address

1231 NW 174TH ST
MIAMI GARDENS FL
33169-5228
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-353020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: