Provider Demographics
NPI:1073962262
Name:PEDROSO, RAUDEL (BEHAVIOR ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RAUDEL
Middle Name:
Last Name:PEDROSO
Suffix:
Gender:M
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5813
Mailing Address - Country:US
Mailing Address - Phone:305-833-1480
Mailing Address - Fax:
Practice Address - Street 1:3251 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5813
Practice Address - Country:US
Practice Address - Phone:305-833-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst