Provider Demographics
NPI:1316551369
Name:CHINEA, NIURIS (BACB536198)
Entity Type:Individual
Prefix:MRS
First Name:NIURIS
Middle Name:
Last Name:CHINEA
Suffix:
Gender:F
Credentials:BACB536198
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 W 56TH ST APT 2124
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4763
Mailing Address - Country:US
Mailing Address - Phone:786-459-8552
Mailing Address - Fax:
Practice Address - Street 1:2510 W 56TH ST APT 2124
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4763
Practice Address - Country:US
Practice Address - Phone:786-459-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-132217106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC513-620-85-872-0OtherDRIVER LICENSE