=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730917477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2024
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14525 SW 43RD TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-344-5720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14525 SW 43RD TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-344-5720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR / PRESIDENT
-----------------------------------------------------
Name | LIZBET RUBIO FERNANDEZ
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 786-344-5720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------