Provider Demographics
NPI:1528768249
Name:ACEVEDO RUIZ, LIZ SHENALITH
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:SHENALITH
Last Name:ACEVEDO RUIZ
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 1:1113 SW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4307
Mailing Address - Country:US
Mailing Address - Phone:305-804-1401
Mailing Address - Fax:
Practice Address - Street 1:11001 SW 76TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2669
Practice Address - Country:US
Practice Address - Phone:305-514-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-258859106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician