Provider Demographics
NPI:1598585796
Name:DEL SOL AMADOR, RENE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:DEL SOL AMADOR
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 1:6415 SW 129TH PL APT 2404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5200
Mailing Address - Country:US
Mailing Address - Phone:561-873-5093
Mailing Address - Fax:
Practice Address - Street 1:6415 SW 129TH PL APT 2404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5200
Practice Address - Country:US
Practice Address - Phone:561-873-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-381323106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty