Provider Demographics
NPI:1497385629
Name:ACOSTA SANCHEZ, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:ACOSTA SANCHEZ
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 1:7620 ABBOTT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2343
Mailing Address - Country:US
Mailing Address - Phone:954-470-9110
Mailing Address - Fax:
Practice Address - Street 1:7620 ABBOTT AVE APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2343
Practice Address - Country:US
Practice Address - Phone:954-470-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-19-108043106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician