Healthcare Provider Details

I. General information

NPI: 1508629338
Provider Name (Legal Business Name): LEIDY IZQUIERDO MELGAREJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19653 NW 59TH AVE
HIALEAH FL
33015-4853
US

IV. Provider business mailing address

11240 FM 1960 RD W STE 209
HOUSTON TX
77065-3664
US

V. Phone/Fax

Practice location:
  • Phone: 561-421-9853
  • Fax:
Mailing address:
  • Phone: 888-880-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberRBT-23-319202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: