Provider Demographics
NPI:1093501496
Name:LEGORBURO, MEYLAN (RBT)
Entity type:Individual
Prefix:
First Name:MEYLAN
Middle Name:
Last Name:LEGORBURO
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 1:1260 MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2363
Mailing Address - Country:US
Mailing Address - Phone:305-518-7805
Mailing Address - Fax:
Practice Address - Street 1:1260 MEDINA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2363
Practice Address - Country:US
Practice Address - Phone:305-518-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-408829106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician