Provider Demographics
NPI:1174340665
Name:EXPOSITO RUBIO, SUSSEL
Entity type:Individual
Prefix:
First Name:SUSSEL
Middle Name:
Last Name:EXPOSITO RUBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NE 123RD ST APT 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6067
Mailing Address - Country:US
Mailing Address - Phone:954-294-8776
Mailing Address - Fax:
Practice Address - Street 1:1550 NE 123RD ST APT 409
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6067
Practice Address - Country:US
Practice Address - Phone:954-294-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24-372151106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician