Provider Demographics
NPI:1407654163
Name:IZQUIERDO AMADOR, ANNYLIE
Entity type:Individual
Prefix:
First Name:ANNYLIE
Middle Name:
Last Name:IZQUIERDO AMADOR
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 1:5452 NW 192ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6121
Mailing Address - Country:US
Mailing Address - Phone:786-399-6773
Mailing Address - Fax:
Practice Address - Street 1:1666 79TH STREET CSWY STE 400
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4189
Practice Address - Country:US
Practice Address - Phone:305-335-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-411079106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician