Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-115997 | FL |
NPI | 1003332321 |
---|---|
Provider Name | Ricardo Silva Cruz |
First Address | Miami Lakes, FL 33015-4555 |
Second Address | Miami Lakes, FL 33015-4555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 11/11/2021 |