Provider Demographics
NPI:1104449495
Name:ABASCAL CERON, ANALEYDIS
Entity type:Individual
Prefix:
First Name:ANALEYDIS
Middle Name:
Last Name:ABASCAL CERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NW 193RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3322
Mailing Address - Country:US
Mailing Address - Phone:305-733-7575
Mailing Address - Fax:
Practice Address - Street 1:120 NW 193RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3322
Practice Address - Country:US
Practice Address - Phone:305-733-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117613106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician