Provider Demographics
NPI:1699252494
Name:SERUTI ZEQUEIRA, REGLA ADNALOY (RBT)
Entity type:Individual
Prefix:
First Name:REGLA
Middle Name:ADNALOY
Last Name:SERUTI ZEQUEIRA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7741 NW 7TH ST APT 707
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6120
Mailing Address - Country:US
Mailing Address - Phone:786-768-6397
Mailing Address - Fax:
Practice Address - Street 1:7741 NW 7TH ST APT 707
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-6120
Practice Address - Country:US
Practice Address - Phone:786-768-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
FL020731200106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020731200Medicaid