Provider Demographics
NPI:1194434936
Name:BORRELL ROMERO, LIUBA
Entity type:Individual
Prefix:
First Name:LIUBA
Middle Name:
Last Name:BORRELL ROMERO
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 1:4540 NW 79TH AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6318
Mailing Address - Country:US
Mailing Address - Phone:786-261-4314
Mailing Address - Fax:
Practice Address - Street 1:4540 NW 79TH AVE APT 1C
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6318
Practice Address - Country:US
Practice Address - Phone:786-261-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-133273103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst