Provider Demographics
NPI:1417556044
Name:ESTRADA, MILEYBI (BACB539353)
Entity Type:Individual
Prefix:
First Name:MILEYBI
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:BACB539353
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4321
Mailing Address - Country:US
Mailing Address - Phone:305-504-0902
Mailing Address - Fax:
Practice Address - Street 1:2871 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4321
Practice Address - Country:US
Practice Address - Phone:305-504-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-140238106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician