Provider Demographics
NPI:1912581851
Name:PAZOS GUEVARA, RAUDEL
Entity Type:Individual
Prefix:
First Name:RAUDEL
Middle Name:
Last Name:PAZOS GUEVARA
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 1:10210 NICARAGUA DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2341
Mailing Address - Country:US
Mailing Address - Phone:786-617-8694
Mailing Address - Fax:
Practice Address - Street 1:10210 NICARAGUA DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2341
Practice Address - Country:US
Practice Address - Phone:786-617-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-143236106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician