Provider Demographics
NPI:1659100857
Name:MAESTRE MACHADO, MIGUEL A
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:MAESTRE MACHADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 SW 77TH CT APT 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4375
Mailing Address - Country:US
Mailing Address - Phone:786-634-7337
Mailing Address - Fax:
Practice Address - Street 1:5500 SW 77TH CT APT 302
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4375
Practice Address - Country:US
Practice Address - Phone:786-634-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-365082106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician