Provider Demographics
NPI:1295440857
Name:BURGOS, ANISLEY (RBT-23-254133)
Entity type:Individual
Prefix:
First Name:ANISLEY
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:RBT-23-254133
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BLUE POINT DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-7641
Mailing Address - Country:US
Mailing Address - Phone:813-325-2389
Mailing Address - Fax:
Practice Address - Street 1:603 BLUE POINT DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-7641
Practice Address - Country:US
Practice Address - Phone:813-325-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician