Provider Demographics
NPI:1578322244
Name:CELADA RUISANCHEZ, RAFAEL (RBT)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:CELADA RUISANCHEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24266 SW 116TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4713
Mailing Address - Country:US
Mailing Address - Phone:786-285-1018
Mailing Address - Fax:
Practice Address - Street 1:24266 SW 116TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4713
Practice Address - Country:US
Practice Address - Phone:786-285-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1090130106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty