Provider Demographics
NPI:1174177919
Name:IZQUIERDO, RENE J
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:J
Last Name:IZQUIERDO
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 1:15499 MIAMI LAKEWAY N APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5536
Mailing Address - Country:US
Mailing Address - Phone:786-780-9261
Mailing Address - Fax:
Practice Address - Street 1:15499 MIAMI LAKEWAY N APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5536
Practice Address - Country:US
Practice Address - Phone:786-780-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician