Provider Demographics
NPI:1316731631
Name:URIZAR, ESTEBAN SAMUEL
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:SAMUEL
Last Name:URIZAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6990
Mailing Address - Country:US
Mailing Address - Phone:305-889-9650
Mailing Address - Fax:
Practice Address - Street 1:12392 SW 82ND AVE # 12392A
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5223
Practice Address - Country:US
Practice Address - Phone:146-656-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1221757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst