Provider Demographics
NPI:1164037438
Name:SULBARAN SANCHEZ, LEONARDO ANDRES
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:ANDRES
Last Name:SULBARAN SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N BAYSHORE DR APT 2211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3011
Mailing Address - Country:US
Mailing Address - Phone:786-918-0743
Mailing Address - Fax:
Practice Address - Street 1:1900 N BAYSHORE DR APT 2211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3011
Practice Address - Country:US
Practice Address - Phone:786-918-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20124299106S00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst