Healthcare Provider Details

I. General information

NPI: 1801594262
Provider Name (Legal Business Name): LUCIANNA ROSA RIBEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 NW 11TH WAY
DEERFIELD BEACH FL
33064-8627
US

IV. Provider business mailing address

5109 NW 11TH WAY
DEERFIELD BCH FL
33064-8627
US

V. Phone/Fax

Practice location:
  • Phone: 321-900-2963
  • Fax:
Mailing address:
  • Phone: 321-900-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-127718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: