Provider Demographics
NPI:1124668801
Name:ALDAZ, ENEIDIS (RBT)
Entity type:Individual
Prefix:
First Name:ENEIDIS
Middle Name:
Last Name:ALDAZ
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 1:305 W 68TH ST APT 315
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10261 NW 72 STREET
Practice Address - Street 2:104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3317
Practice Address - Country:US
Practice Address - Phone:305-422-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-99361106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician