Provider Demographics
NPI:1518714831
Name:ZADA RUEDA, ILIANY (RBT)
Entity type:Individual
Prefix:
First Name:ILIANY
Middle Name:
Last Name:ZADA RUEDA
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 1:2395 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4404
Mailing Address - Country:US
Mailing Address - Phone:786-532-3500
Mailing Address - Fax:
Practice Address - Street 1:2395 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4404
Practice Address - Country:US
Practice Address - Phone:786-532-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24343887106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician