Provider Demographics
NPI:1508375494
Name:ALMIRA LANDIVAR, DUGLAS ALBERTO (RBT)
Entity type:Individual
Prefix:
First Name:DUGLAS
Middle Name:ALBERTO
Last Name:ALMIRA LANDIVAR
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 SW 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5428
Mailing Address - Country:US
Mailing Address - Phone:786-606-6296
Mailing Address - Fax:
Practice Address - Street 1:3812 SW 89TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5428
Practice Address - Country:US
Practice Address - Phone:786-606-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid