Healthcare Provider Details

I. General information

NPI: 1659915700
Provider Name (Legal Business Name): LETICIA ESTRADA INFANTE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NW 207TH ST APT 308
MIAMI GARDENS FL
33169-3153
US

IV. Provider business mailing address

650 NW 207TH ST APT 308
MIAMI GARDENS FL
33169-3153
US

V. Phone/Fax

Practice location:
  • Phone: 786-985-4778
  • Fax:
Mailing address:
  • Phone: 786-985-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-103098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: