Provider Demographics
NPI:1730823022
Name:MEDEL CUELLAR, XENIA (RBT)
Entity type:Individual
Prefix:
First Name:XENIA
Middle Name:
Last Name:MEDEL CUELLAR
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 1:19261 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7720
Mailing Address - Country:US
Mailing Address - Phone:786-608-5600
Mailing Address - Fax:
Practice Address - Street 1:19261 STERLING DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7720
Practice Address - Country:US
Practice Address - Phone:786-608-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician