Provider Demographics
NPI:1487495214
Name:MONTEAGUDO DE LA GUARDIA, LUIS ALBERTO (RBT-24-346430)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:MONTEAGUDO DE LA GUARDIA
Suffix:
Gender:M
Credentials:RBT-24-346430
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3516
Mailing Address - Country:US
Mailing Address - Phone:561-850-1062
Mailing Address - Fax:
Practice Address - Street 1:3104 W WATERS AVE STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2877
Practice Address - Country:US
Practice Address - Phone:813-265-4439
Practice Address - Fax:813-513-0065
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-346430106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician