Provider Demographics
NPI:1922873736
Name:RICABAL MIGUELES, DAYRON A
Entity Type:Individual
Prefix:
First Name:DAYRON
Middle Name:A
Last Name:RICABAL MIGUELES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6310
Mailing Address - Country:US
Mailing Address - Phone:510-637-9852
Mailing Address - Fax:
Practice Address - Street 1:9104 NW 164TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-6310
Practice Address - Country:US
Practice Address - Phone:510-637-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23311466106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician