Provider Demographics
NPI:1174392963
Name:QUINTERO GOMEZ, DAYENSI (RBT)
Entity type:Individual
Prefix:
First Name:DAYENSI
Middle Name:
Last Name:QUINTERO GOMEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3253
Mailing Address - Country:US
Mailing Address - Phone:786-489-7427
Mailing Address - Fax:
Practice Address - Street 1:6950 NW 186TH ST APT 308
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-3290
Practice Address - Country:US
Practice Address - Phone:786-489-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-306245106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician