Provider Demographics
NPI:1568968675
Name:SALAZAR LEON, ACDIMARA
Entity Type:Individual
Prefix:
First Name:ACDIMARA
Middle Name:
Last Name:SALAZAR LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21398 NW 40TH CIRCLE CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1168
Mailing Address - Country:US
Mailing Address - Phone:786-543-7196
Mailing Address - Fax:
Practice Address - Street 1:21398 NW 40TH CIRCLE CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1168
Practice Address - Country:US
Practice Address - Phone:786-543-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20121898106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician