Provider Demographics
NPI:1306377502
Name:VIZCAINO, RICARDO SR
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:VIZCAINO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 OLD CUTLER RD
Mailing Address - Street 2:APTO 112
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1723
Mailing Address - Country:US
Mailing Address - Phone:786-525-7908
Mailing Address - Fax:
Practice Address - Street 1:10423 OLD CUTLER RD
Practice Address - Street 2:APTO 112
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1723
Practice Address - Country:US
Practice Address - Phone:786-525-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst