Provider Demographics
NPI:1619781879
Name:BAEZ SOSA, JOSE RAMON (RBT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:BAEZ SOSA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6126
Mailing Address - Country:US
Mailing Address - Phone:689-254-2149
Mailing Address - Fax:
Practice Address - Street 1:6881 KINGSPOINTE PKWY STE 18
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-6535
Practice Address - Country:US
Practice Address - Phone:888-900-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-402216106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician