Provider Demographics
NPI:1558948174
Name:LOAYZA, LOURDES (RBT)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:LOAYZA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 HILLCREST DR APT 403
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7978
Mailing Address - Country:US
Mailing Address - Phone:954-548-5852
Mailing Address - Fax:
Practice Address - Street 1:4400 HILLCREST DR APT 403
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7978
Practice Address - Country:US
Practice Address - Phone:954-548-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician