Healthcare Provider Details

I. General information

NPI: 1013688167
Provider Name (Legal Business Name): CHRISTIAN CUENCA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 ORION LN
WESTON FL
33327-2327
US

IV. Provider business mailing address

4839 SUNKIST WAY
COOPER CITY FL
33330-8806
US

V. Phone/Fax

Practice location:
  • Phone: 954-515-9405
  • Fax:
Mailing address:
  • Phone: 954-515-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-73920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: