Provider Demographics
NPI:1245738624
Name:TRINIDAD PLAZA, CHEYLAN
Entity Type:Individual
Prefix:
First Name:CHEYLAN
Middle Name:
Last Name:TRINIDAD PLAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19425 SW 117TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4410
Mailing Address - Country:US
Mailing Address - Phone:786-337-5285
Mailing Address - Fax:
Practice Address - Street 1:19425 SW 117TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4410
Practice Address - Country:US
Practice Address - Phone:786-337-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician