Provider Demographics
NPI:1871037390
Name:DUQUE, ELEDEIZA
Entity type:Individual
Prefix:
First Name:ELEDEIZA
Middle Name:
Last Name:DUQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14243 SW 116TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8625
Mailing Address - Country:US
Mailing Address - Phone:305-305-6526
Mailing Address - Fax:786-334-5826
Practice Address - Street 1:14243 SW 166TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1826
Practice Address - Country:US
Practice Address - Phone:305-305-6526
Practice Address - Fax:786-334-5826
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-436643106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician