Provider Demographics
NPI:1588449540
Name:SIERRA CALAFET, BORIS LUIS
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:LUIS
Last Name:SIERRA CALAFET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13306 55TH RD N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8325
Mailing Address - Country:US
Mailing Address - Phone:561-602-0855
Mailing Address - Fax:
Practice Address - Street 1:13306 55TH RD N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8325
Practice Address - Country:US
Practice Address - Phone:561-602-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-290788106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician