Provider Demographics
NPI:1245886803
Name:CURBELO, RANDY LAZARO II (RBT)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LAZARO
Last Name:CURBELO
Suffix:II
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:LAZARO
Other - Last Name:CURBELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:3841 NW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4534
Mailing Address - Country:US
Mailing Address - Phone:305-587-6692
Mailing Address - Fax:
Practice Address - Street 1:3841 NW 171ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4534
Practice Address - Country:US
Practice Address - Phone:305-587-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-69758106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021537500Medicaid