Provider Demographics
NPI:1417835380
Name:IZAGUIRRE FUENTES, RAQUEL (RBT)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:IZAGUIRRE FUENTES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 DEERBROOKE CREEK CIR APT 12
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2813
Mailing Address - Country:US
Mailing Address - Phone:786-754-1654
Mailing Address - Fax:
Practice Address - Street 1:6601 MEMORIAL HWY STE 106
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4501
Practice Address - Country:US
Practice Address - Phone:813-749-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician