Provider Demographics
NPI:1992529481
Name:RUIZ SOLOZABAL, ENDRY RAFAEL
Entity type:Individual
Prefix:
First Name:ENDRY
Middle Name:RAFAEL
Last Name:RUIZ SOLOZABAL
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 1:9545 SW 24TH ST APT B312
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8054
Mailing Address - Country:US
Mailing Address - Phone:305-968-5511
Mailing Address - Fax:
Practice Address - Street 1:9545 SW 24TH ST APT B312
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8054
Practice Address - Country:US
Practice Address - Phone:305-968-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-389932106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician