Provider Demographics
NPI:1003677782
Name:BORRREGO RODRIGUEZ, DORALYS (RBT)
Entity Type:Individual
Prefix:
First Name:DORALYS
Middle Name:
Last Name:BORRREGO RODRIGUEZ
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 1:22424 SW 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5936
Mailing Address - Country:US
Mailing Address - Phone:954-705-8412
Mailing Address - Fax:
Practice Address - Street 1:22424 SW 66TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5936
Practice Address - Country:US
Practice Address - Phone:954-705-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-313869106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician