Provider Demographics
NPI:1427864362
Name:MEDEROS URRA, ADIANEZ (RBT-24-394760)
Entity type:Individual
Prefix:
First Name:ADIANEZ
Middle Name:
Last Name:MEDEROS URRA
Suffix:
Gender:F
Credentials:RBT-24-394760
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5378 HAWKS LANDING DR APT 204
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-6670
Mailing Address - Country:US
Mailing Address - Phone:786-948-1130
Mailing Address - Fax:
Practice Address - Street 1:5378 HAWKS LANDING DR APT 204
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-6670
Practice Address - Country:US
Practice Address - Phone:786-948-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-394760106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician