Provider Demographics
NPI:1073355541
Name:LUZARDO CABO, ISMAELIS (RBT)
Entity type:Individual
Prefix:
First Name:ISMAELIS
Middle Name:
Last Name:LUZARDO CABO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 NW 183RD LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2951
Mailing Address - Country:US
Mailing Address - Phone:786-365-8661
Mailing Address - Fax:
Practice Address - Street 1:8300 W FLAGLER ST STE 170
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2098
Practice Address - Country:US
Practice Address - Phone:786-633-5171
Practice Address - Fax:786-558-9279
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352068106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician