=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730988262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMILA ANDREA ESPINOSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2025
-----------------------------------------------------
Last Update Date | 03/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14125 NW 80TH AVE STE 304
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-305-7222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10312 NW 24TH PL APT 205
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33322-7026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-234-5932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-25-407369
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------