Provider Demographics
NPI:1629796883
Name:MASMELA-ARROYAVE, MARIA CAMILA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CAMILA
Last Name:MASMELA-ARROYAVE
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 1:11701 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3901
Mailing Address - Country:US
Mailing Address - Phone:561-667-1264
Mailing Address - Fax:
Practice Address - Street 1:11701 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-3901
Practice Address - Country:US
Practice Address - Phone:561-667-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB699799106S00000X
FLRBT-22-224205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician