Provider Demographics
NPI:1568350817
Name:PULIDO AYESTARAN, DAIRON JOSE
Entity type:Individual
Prefix:
First Name:DAIRON
Middle Name:JOSE
Last Name:PULIDO AYESTARAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NW 18TH AVE APT 807
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-6242
Mailing Address - Country:US
Mailing Address - Phone:305-481-4320
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 8180NW36
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:866-521-5307
Practice Address - Fax:305-429-5154
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-444433106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician