Provider Demographics
NPI:1093461303
Name:CUBA MEDINA, LAURENT (RBT 22-202771)
Entity Type:Individual
Prefix:MS
First Name:LAURENT
Middle Name:
Last Name:CUBA MEDINA
Suffix:
Gender:F
Credentials:RBT 22-202771
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 LAKEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8215
Mailing Address - Country:US
Mailing Address - Phone:561-537-6478
Mailing Address - Fax:
Practice Address - Street 1:2676 LAKEHAVEN RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-8215
Practice Address - Country:US
Practice Address - Phone:561-537-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty