Organization
ADVANCE BEHAVIORAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONIA TERESA CISNEROS VAZQUEZ (PRESIDENT)
(059) 647-4973
Entity
Organization
Contact information
Practice address
11490 QUAIL ROOST DR, MIAMI, FL 33157-6575
(305) 964-7497
Mailing address
11490 QUAIL ROOST DR, MIAMI, FL 33157-6575
(305) 964-7497
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
01/28/2019
Last updated
01/28/2019
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