Provider Demographics
NPI:1407579550
Name:PEDRAZA, CONCEPCION (RBT-21-184137)
Entity Type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:RBT-21-184137
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14511 SW 297TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3930
Mailing Address - Country:US
Mailing Address - Phone:786-546-3547
Mailing Address - Fax:
Practice Address - Street 1:11276 SW 232ND ST
Practice Address - Street 2:
Practice Address - City:GOULDS
Practice Address - State:FL
Practice Address - Zip Code:33170-7505
Practice Address - Country:US
Practice Address - Phone:305-912-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-184137106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician