MEDICARE: NIEBLA BEHAVIOR THERAPY SOLUTION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1790560712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIEBLA BEHAVIOR THERAPY SOLUTION INC

Provider Business Mailing Address
First Line	:	2912 NW 49TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-3557
Country	:	US
Telephone Number	:	786-622-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 NW 49TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-3557
Country	:	US
Telephone Number	:	786-622-6497
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IVEISY NIEBLA RAYA
Credential	:
Telephone Number	:	786-622-6497

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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