Provider Demographics
NPI:1649023102
Name:FLORES ZULUETA, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FLORES ZULUETA
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 1:9403 SW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4441
Mailing Address - Country:US
Mailing Address - Phone:786-826-5711
Mailing Address - Fax:
Practice Address - Street 1:9403 SW 170TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4441
Practice Address - Country:US
Practice Address - Phone:786-826-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician