Provider Demographics
NPI:1407627227
Name:LOPEZ BANOS, ODALYS (RBT-24-320257)
Entity Type:Individual
Prefix:
First Name:ODALYS
Middle Name:
Last Name:LOPEZ BANOS
Suffix:
Gender:F
Credentials:RBT-24-320257
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13530 SW 116TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8331
Mailing Address - Country:US
Mailing Address - Phone:305-337-1811
Mailing Address - Fax:
Practice Address - Street 1:13530 SW 116TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8331
Practice Address - Country:US
Practice Address - Phone:305-337-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-320257106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician