Provider Demographics
NPI:1245890797
Name:DARIAS, LESTER RAIMOS
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:RAIMOS
Last Name:DARIAS
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 1:3112 NW 100TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5916
Mailing Address - Country:US
Mailing Address - Phone:786-863-4767
Mailing Address - Fax:
Practice Address - Street 1:3112 NW 100TH CT
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5916
Practice Address - Country:US
Practice Address - Phone:786-863-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-77721106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician