Active NPI
Nelson M Gutierrez Condis
- Behavior Technician
- Miramar, FL
National Provider Identifier
1932934411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-374663
- Practice address
- 6171 SW 41St St
Miramar, FL 33023-5102 - Phone
- (585) 503-5876
- NPI assigned
- Sep 4, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-24-374663 | FL | Primary |
Addresses
Primary practice location
6171 SW 41St St
Miramar, FL 33023-5102
Mailing address
6171 SW 41St St
Miramar, FL 33023-5102
Phone (585) 503-5876
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123978400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-24-374663 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1932934411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6171 SW 41ST ST",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330235102",
"telephone_number": "585-503-5876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6171 SW 41ST ST",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330235102",
"telephone_number": "585-503-5876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ CONDIS",
"first_name": "NELSON",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-09-04",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-24-374663",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123978400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miramar, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.