Provider Demographics
NPI:1558254649
Name:NIXON, LOURDES MARIA
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:MARIA
Last Name:NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LOURDES
Other - Middle Name:MARIA
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15575 MIAMI LAKEWAY N APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5577
Mailing Address - Country:US
Mailing Address - Phone:305-720-3836
Mailing Address - Fax:
Practice Address - Street 1:7875 NW 12TH ST STE 110
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1815
Practice Address - Country:US
Practice Address - Phone:786-269-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-417237106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician