Provider Demographics
NPI:1932863131
Name:MONAGAS DE CORONIL, NEYRA E (RBT)
Entity Type:Individual
Prefix:
First Name:NEYRA
Middle Name:E
Last Name:MONAGAS DE CORONIL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 NW 87TH AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2440
Mailing Address - Country:US
Mailing Address - Phone:786-483-0940
Mailing Address - Fax:
Practice Address - Street 1:1016 NW 87TH AVE APT 103
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2440
Practice Address - Country:US
Practice Address - Phone:786-483-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122709106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110212500Medicaid