Provider Demographics
NPI:1295392223
Name:ALCANTARA, RUTH MARIANNY
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MARIANNY
Last Name:ALCANTARA
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 1:6691 COW PEN RD APT A202
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6632
Mailing Address - Country:US
Mailing Address - Phone:256-650-5789
Mailing Address - Fax:
Practice Address - Street 1:6691 COW PEN RD APT A202
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6632
Practice Address - Country:US
Practice Address - Phone:256-650-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty