Provider Demographics
NPI:1710672290
Name:FIGUEROA LAGO, ODALIA (RBT)
Entity Type:Individual
Prefix:
First Name:ODALIA
Middle Name:
Last Name:FIGUEROA LAGO
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 1:27541 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8291
Mailing Address - Country:US
Mailing Address - Phone:786-765-7235
Mailing Address - Fax:
Practice Address - Street 1:27541 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8291
Practice Address - Country:US
Practice Address - Phone:786-765-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-120068106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician