Provider Demographics
NPI:1902463474
Name:IZQUIERDO ACOSTA, ADAIBYS
Entity Type:Individual
Prefix:
First Name:ADAIBYS
Middle Name:
Last Name:IZQUIERDO ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11441 LAKESIDE DR APT 2110
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3040
Mailing Address - Country:US
Mailing Address - Phone:786-308-5211
Mailing Address - Fax:
Practice Address - Street 1:11441 LAKESIDE DR APT 2110
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3040
Practice Address - Country:US
Practice Address - Phone:786-308-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-20-11630106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician