Provider Demographics
NPI:1336959055
Name:ESPRONCEDA TAMAYO, DAMISELA
Entity type:Individual
Prefix:
First Name:DAMISELA
Middle Name:
Last Name:ESPRONCEDA TAMAYO
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 1:4141 SW 99TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5048
Mailing Address - Country:US
Mailing Address - Phone:786-803-4410
Mailing Address - Fax:
Practice Address - Street 1:4141 SW 99TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5048
Practice Address - Country:US
Practice Address - Phone:786-803-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty