Provider Demographics
NPI:1114614344
Name:CALDERON LEIVA, BEATRIZ
Entity Type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:
Last Name:CALDERON LEIVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 NW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2835
Mailing Address - Country:US
Mailing Address - Phone:786-985-9007
Mailing Address - Fax:
Practice Address - Street 1:2963 NW 55TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-2835
Practice Address - Country:US
Practice Address - Phone:786-985-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC436-060-98-882-0106S00000X
FLRBT-23-266833106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician