Provider Demographics
NPI:1861140782
Name:TIRADO, ANILADI (RBT)
Entity type:Individual
Prefix:
First Name:ANILADI
Middle Name:
Last Name:TIRADO
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 1:12467 SW 17TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1564
Mailing Address - Country:US
Mailing Address - Phone:305-213-4057
Mailing Address - Fax:
Practice Address - Street 1:12467 SW 17TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-1564
Practice Address - Country:US
Practice Address - Phone:305-213-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT631-000-74-717-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107618300Medicaid