Provider Demographics
NPI:1700690138
Name:IZQUIERDO MENESES, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:IZQUIERDO MENESES
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 1:8670 SW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2330
Mailing Address - Country:US
Mailing Address - Phone:786-205-3745
Mailing Address - Fax:
Practice Address - Street 1:8670 SW 32ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2330
Practice Address - Country:US
Practice Address - Phone:786-205-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-399031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician