Provider Demographics
NPI:1497582415
Name:SANCHEZ RONDON, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:SANCHEZ RONDON
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 1:11890 SW 8TH ST STE 213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1742
Mailing Address - Country:US
Mailing Address - Phone:786-763-9272
Mailing Address - Fax:
Practice Address - Street 1:11890 SW 8TH ST STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1742
Practice Address - Country:US
Practice Address - Phone:786-763-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-377163106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician