Individual
AMANDA LIANE RUGAMA LEIVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13195 SW 134TH ST STE 201, MIAMI, FL 33186-4585
(305) 766-3097
Mailing address
3801 SW 153RD CT, MIAMI, FL 33185-4706
(305) 766-3097
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
FL
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023465900
—
FL
Enumeration date
01/20/2018
Last updated
06/06/2022
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