Provider Demographics
NPI:1487426458
Name:LAVASTIDA MENENDEZ, FRANK G (RBT)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:G
Last Name:LAVASTIDA MENENDEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15264 SW 32ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4791
Mailing Address - Country:US
Mailing Address - Phone:786-768-9526
Mailing Address - Fax:
Practice Address - Street 1:15264 SW 32ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4791
Practice Address - Country:US
Practice Address - Phone:786-768-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-303980106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120108900Medicaid