Provider Demographics
NPI:1346839800
Name:MIQUILENA CONTRERAS, ILEANA MARIA
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:MARIA
Last Name:MIQUILENA CONTRERAS
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 1:3160 SMOKE SIGNAL CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4616
Mailing Address - Country:US
Mailing Address - Phone:407-591-6338
Mailing Address - Fax:
Practice Address - Street 1:2208 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3436
Practice Address - Country:US
Practice Address - Phone:407-201-6255
Practice Address - Fax:407-201-7195
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-68910106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician