Provider Demographics
NPI:1972375707
Name:CABEZAS BRUNET, RACHEL TALIA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:TALIA
Last Name:CABEZAS BRUNET
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 1:13438SW 291ST STREET
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033
Mailing Address - Country:US
Mailing Address - Phone:786-586-1653
Mailing Address - Fax:
Practice Address - Street 1:13438SW 291ST STREET
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033
Practice Address - Country:US
Practice Address - Phone:786-586-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-266236106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty