Healthcare Provider Details

I. General information

NPI: 1922618693
Provider Name (Legal Business Name): LETICIA ROIG RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 NW 53RD ST STE 350
MIAMI FL
33166-7712
US

IV. Provider business mailing address

5845 SW 144TH CIRCLE PL
MIAMI FL
33183-1073
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-2195
  • Fax: 561-828-3124
Mailing address:
  • Phone: 305-776-0728
  • Fax: 561-828-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-121355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: