Provider Demographics
NPI:1003483488
Name:REGUEIRO GONZALEZ, LISANDRA (RBT)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:REGUEIRO GONZALEZ
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 1:1275 W 26TH PL APT 14
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1026
Mailing Address - Country:US
Mailing Address - Phone:786-365-8065
Mailing Address - Fax:
Practice Address - Street 1:13500 SW 88TH ST UNIT 285
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1515
Practice Address - Country:US
Practice Address - Phone:786-706-2366
Practice Address - Fax:786-953-6553
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108226000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician