Healthcare Provider Details

I. General information

NPI: 1013594720
Provider Name (Legal Business Name): DAIMI QUESADA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LAKE CHARLOTTE CREEK DR
BASTROP TX
78602-2286
US

IV. Provider business mailing address

111 LAKE CHARLOTTE CREEK DR
BASTROP TX
78602-2286
US

V. Phone/Fax

Practice location:
  • Phone: 786-757-9224
  • Fax:
Mailing address:
  • Phone: 786-757-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: