Provider Demographics
NPI:1487291696
Name:CUNILL ORTIZ, ANA A (RBT-19-104142)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:A
Last Name:CUNILL ORTIZ
Suffix:
Gender:F
Credentials:RBT-19-104142
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W 44TH PL APT 209
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3364
Mailing Address - Country:US
Mailing Address - Phone:786-234-3590
Mailing Address - Fax:
Practice Address - Street 1:1355 W 44TH PL APT 209
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3364
Practice Address - Country:US
Practice Address - Phone:786-234-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-19-104142106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician