Provider Demographics
NPI:1255116539
Name:COLLADO LARRAMENDI, ALEJANDRO ENRIQUE
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ENRIQUE
Last Name:COLLADO LARRAMENDI
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 1:9800 CARIBBEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1521
Mailing Address - Country:US
Mailing Address - Phone:954-299-9445
Mailing Address - Fax:
Practice Address - Street 1:9800 CARIBBEAN BLVD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1521
Practice Address - Country:US
Practice Address - Phone:954-299-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-284136106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician