Provider Demographics
NPI:1215809363
Name:BORREGO, LIUDMILA (RBT)
Entity type:Individual
Prefix:
First Name:LIUDMILA
Middle Name:
Last Name:BORREGO
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 1:891 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5161
Mailing Address - Country:US
Mailing Address - Phone:786-314-2296
Mailing Address - Fax:
Practice Address - Street 1:9380 SW 72ND ST STE B224
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5460
Practice Address - Country:US
Practice Address - Phone:786-353-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB620-520-75-512-2106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty