Provider Demographics
NPI:1073348215
Name:RAMOS DIAZ, LISANDRA (RBT)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:RAMOS DIAZ
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 NW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2957
Mailing Address - Country:US
Mailing Address - Phone:561-679-2829
Mailing Address - Fax:
Practice Address - Street 1:8300 NW 53RD ST STE 350
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-7712
Practice Address - Country:US
Practice Address - Phone:305-833-0772
Practice Address - Fax:561-828-3124
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-358128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125332200Medicaid