Provider Demographics
NPI:1891118840
Name:IZQUIERDO, ISABELLA (BCBA)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 SANS SOUCI BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3035
Mailing Address - Country:US
Mailing Address - Phone:305-479-7197
Mailing Address - Fax:
Practice Address - Street 1:9350 SW 72ND ST STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3245
Practice Address - Country:US
Practice Address - Phone:305-279-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-42307103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst