Provider Demographics
NPI:1164666343
Name:GUARDADO LOPEZ, ROLANDO (RBT)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:GUARDADO LOPEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SW 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5638
Mailing Address - Country:US
Mailing Address - Phone:786-372-5508
Mailing Address - Fax:
Practice Address - Street 1:1450 SW 63RD AVE
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5638
Practice Address - Country:US
Practice Address - Phone:786-372-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician