1720605017 NPI number — LEBREDO BEHAVIOR ANALYSIS SERVICES CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720605017 NPI number — LEBREDO BEHAVIOR ANALYSIS SERVICES CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEBREDO BEHAVIOR ANALYSIS SERVICES CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720605017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18064 SW 20TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029-5209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-399-8439
Provider Business Mailing Address Fax Number:
561-619-7423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11820 MIRAMAR PKWY STE 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-399-8439
Provider Business Practice Location Address Fax Number:
561-619-7423
Provider Enumeration Date:
07/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LEBREDO
Authorized Official First Name:
INGRID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-399-8439

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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