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General NPI Number Information
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NPI Number | 1740756766
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Entity Type | Individual
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Provider Name | BORIS LEDESMA HUETE
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Gender | Male
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 9290 HAMMOCKS BLVD STE 401
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City | MIAMI
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State | FL
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Zip | 33196-1347
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Country | US
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Telephone | 786-558-5694
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Fax | 786-913-7034
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Provider Business Mailing Address
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Address Line | 15650 SW 141ST CT
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City | MIAMI
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State | FL
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Zip | 33177-1099
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Country | US
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Telephone | 786-612-0746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-62936
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License Number State | FL
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