Provider Demographics
NPI:1285081034
Name:BAJUELOS, LEYDY
Entity type:Individual
Prefix:
First Name:LEYDY
Middle Name:
Last Name:BAJUELOS
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 1:13957 SW 44TH LANE CIR APT B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4438
Mailing Address - Country:US
Mailing Address - Phone:786-222-9784
Mailing Address - Fax:
Practice Address - Street 1:13957 SW 44TH LANE CIR APT B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4438
Practice Address - Country:US
Practice Address - Phone:786-222-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171W00000XOther Service ProvidersContractor