Provider Demographics
NPI:1114617446
Name:MATOS DANTIN, LEYANES I
Entity Type:Individual
Prefix:
First Name:LEYANES
Middle Name:
Last Name:MATOS DANTIN
Suffix:I
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 1:9917 W OKEECHOBEE RD APT 4314
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3154
Mailing Address - Country:US
Mailing Address - Phone:786-768-1720
Mailing Address - Fax:
Practice Address - Street 1:9917 W OKEECHOBEE RD APT 4314
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-3154
Practice Address - Country:US
Practice Address - Phone:786-768-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-245902106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician