Provider Demographics
NPI:1285316208
Name:ABRAHANTE RUILOBA, MERCEDES DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:DE LA CARIDAD
Last Name:ABRAHANTE RUILOBA
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 1:1820 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3564
Mailing Address - Country:US
Mailing Address - Phone:305-889-9634
Mailing Address - Fax:
Practice Address - Street 1:1820 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3564
Practice Address - Country:US
Practice Address - Phone:305-889-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-288234106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician