Provider Demographics
NPI:1346730272
Name:DONOSO, CECILIA D
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:D
Last Name:DONOSO
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 1:18901 NE 14TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4038
Mailing Address - Country:US
Mailing Address - Phone:305-318-6260
Mailing Address - Fax:
Practice Address - Street 1:18200 NE 7TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1160
Practice Address - Country:US
Practice Address - Phone:954-410-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-55599106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician