Provider Demographics
NPI:1467210229
Name:SAN MARTIN CORREA, MISLEIDYS (RBT)
Entity type:Individual
Prefix:MS
First Name:MISLEIDYS
Middle Name:
Last Name:SAN MARTIN CORREA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 GRAND CANAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2527
Mailing Address - Country:US
Mailing Address - Phone:786-294-3799
Mailing Address - Fax:
Practice Address - Street 1:173 GRAND CANAL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2527
Practice Address - Country:US
Practice Address - Phone:786-294-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-322099106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician