Provider Demographics
NPI:1699000117
Name:ZALDIVAR, LUIS R (PHD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:ZALDIVAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 SW 95TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3459
Mailing Address - Country:US
Mailing Address - Phone:786-387-9386
Mailing Address - Fax:305-234-6500
Practice Address - Street 1:16201 SW 95TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3459
Practice Address - Country:US
Practice Address - Phone:786-387-9386
Practice Address - Fax:305-234-6500
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY003628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical