Provider Demographics
NPI:1477357911
Name:BADILLA, RYAN ANTHONY (RBT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANTHONY
Last Name:BADILLA
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4510
Mailing Address - Country:US
Mailing Address - Phone:305-377-3297
Mailing Address - Fax:
Practice Address - Street 1:751 NE 75TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5275
Practice Address - Country:US
Practice Address - Phone:786-354-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-417736106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician