Provider Demographics
NPI:1659915700
Name:ESTRADA INFANTE, LETICIA (RBT)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ESTRADA INFANTE
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 1:7401 NW 2ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4101
Mailing Address - Country:US
Mailing Address - Phone:786-985-4778
Mailing Address - Fax:
Practice Address - Street 1:7401 NW 2ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4101
Practice Address - Country:US
Practice Address - Phone:786-985-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-103098106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician