Provider Demographics
NPI:1548790660
Name:PIQUERA, GUILLERMO GERARDO
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:GERARDO
Last Name:PIQUERA
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 1:9900 SW 88TH ST APT K307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1744
Mailing Address - Country:US
Mailing Address - Phone:786-219-7203
Mailing Address - Fax:
Practice Address - Street 1:9900 SW 88TH ST APT K307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1744
Practice Address - Country:US
Practice Address - Phone:786-219-7203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
0-19-9881106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician