Provider Demographics
NPI:1497102123
Name:LLERAS, DAVID NOE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NOE
Last Name:LLERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 FONTAINEBLEAU BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3238
Mailing Address - Country:US
Mailing Address - Phone:786-250-7622
Mailing Address - Fax:
Practice Address - Street 1:10201 FONTAINEBLEAU BLVD APT 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3238
Practice Address - Country:US
Practice Address - Phone:786-250-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-15-07429106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician