Provider Demographics
NPI:1952009748
Name:RELOBA SEREN, AILIS
Entity type:Individual
Prefix:
First Name:AILIS
Middle Name:
Last Name:RELOBA SEREN
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 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:944-854-1116
Mailing Address - Fax:
Practice Address - Street 1:11506 SW 175TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3987
Practice Address - Country:US
Practice Address - Phone:786-286-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR412-000-95-771-0OtherLICENCE DRIVERS
FLRBT-20-133818OtherRBT CERTIFICACCION NUMBER