Provider Demographics
NPI:1962204925
Name:FUENTE VALDIVIA, LEONARDO ALEXIS (RBT)
Entity type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:ALEXIS
Last Name:FUENTE VALDIVIA
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2810
Mailing Address - Country:US
Mailing Address - Phone:754-230-8576
Mailing Address - Fax:
Practice Address - Street 1:6412 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2810
Practice Address - Country:US
Practice Address - Phone:754-230-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician