Provider Demographics
NPI:1629691282
Name:VAZQUEZ SARDINAS, LEYDIS M
Entity Type:Individual
Prefix:
First Name:LEYDIS
Middle Name:M
Last Name:VAZQUEZ SARDINAS
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 1:11020 SW 196TH ST APT B213
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8304
Mailing Address - Country:US
Mailing Address - Phone:786-247-7249
Mailing Address - Fax:
Practice Address - Street 1:11020 SW 196TH ST APT B213
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8304
Practice Address - Country:US
Practice Address - Phone:786-247-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117700106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician