Provider Demographics
NPI:1417555376
Name:CABANA TAPIA, JUAN C (RBT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:CABANA TAPIA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 MANUEL ST E
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-5704
Mailing Address - Country:US
Mailing Address - Phone:786-260-4822
Mailing Address - Fax:
Practice Address - Street 1:2519 39TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-6849
Practice Address - Country:US
Practice Address - Phone:786-260-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20125706103K00000X
FLRBT-20-125706106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst