Provider Demographics
NPI:1306100839
Name:AVILES CRUZ, SANDRA (RBT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:AVILES CRUZ
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 1:1127 SEA PINES WAY
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4246
Mailing Address - Country:US
Mailing Address - Phone:561-752-6320
Mailing Address - Fax:888-352-6943
Practice Address - Street 1:1127 SEA PINES WAY
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4246
Practice Address - Country:US
Practice Address - Phone:561-752-6320
Practice Address - Fax:888-352-6943
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232581172V00000X
FLRBT-23-256453106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-23-256453Medicaid