Provider Demographics
NPI:1720868250
Name:RETE-ESCOBAR, DANIELA DE JESUS (RBT-23-292499)
Entity Type:Individual
Prefix:
First Name:DANIELA DE JESUS
Middle Name:
Last Name:RETE-ESCOBAR
Suffix:
Gender:F
Credentials:RBT-23-292499
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 SW 267TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8268
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14221 SW 267TH ST APT 106
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8268
Practice Address - Country:US
Practice Address - Phone:786-909-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-292499106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician