Provider Demographics
NPI:1245070226
Name:ALBA, LUIS ERNESTO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:ALBA
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 1:6793 SW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4801
Mailing Address - Country:US
Mailing Address - Phone:754-275-7403
Mailing Address - Fax:
Practice Address - Street 1:6793 SW 27TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4801
Practice Address - Country:US
Practice Address - Phone:754-275-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician