Provider Demographics
NPI:1063202877
Name:SARDINAS CRUZ, DORAYMIS
Entity type:Individual
Prefix:
First Name:DORAYMIS
Middle Name:
Last Name:SARDINAS CRUZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8814 NW 153RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1354
Mailing Address - Country:US
Mailing Address - Phone:786-394-3259
Mailing Address - Fax:
Practice Address - Street 1:7975 NW 154TH ST STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5849
Practice Address - Country:US
Practice Address - Phone:305-874-7245
Practice Address - Fax:305-874-7245
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-433956106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician