Provider Demographics
NPI:1205527041
Name:MONZON, LEANDRO JAVIER
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:JAVIER
Last Name:MONZON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 SW 36TH CT
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6107
Mailing Address - Country:US
Mailing Address - Phone:754-230-6885
Mailing Address - Fax:
Practice Address - Street 1:5601 SW 36TH CT
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-6107
Practice Address - Country:US
Practice Address - Phone:754-230-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-273109106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician