Provider Demographics
NPI:1508535881
Name:MEJIA BETANCUR, CRISTIAN O
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:O
Last Name:MEJIA BETANCUR
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 1:13501 SW 128TH ST STE 114-1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5882
Mailing Address - Country:US
Mailing Address - Phone:786-732-2139
Mailing Address - Fax:
Practice Address - Street 1:13501 SW 128TH ST STE 114-1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5882
Practice Address - Country:US
Practice Address - Phone:786-732-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician