Provider Demographics
NPI:1770322414
Name:RUIZ ALONSO, AMADO M
Entity type:Individual
Prefix:
First Name:AMADO
Middle Name:M
Last Name:RUIZ ALONSO
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 1:15931 SW 284TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1140
Mailing Address - Country:US
Mailing Address - Phone:786-202-4799
Mailing Address - Fax:
Practice Address - Street 1:15931 SW 284TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1140
Practice Address - Country:US
Practice Address - Phone:786-202-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24-346243106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician