Provider Demographics
NPI:1447819644
Name:GUEVARA RUIZ, BETSY (RBT-19-85910)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:GUEVARA RUIZ
Suffix:
Gender:F
Credentials:RBT-19-85910
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8776 SW 12TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3376
Mailing Address - Country:US
Mailing Address - Phone:786-830-4316
Mailing Address - Fax:
Practice Address - Street 1:9290 HAMMOCKS BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1347
Practice Address - Country:US
Practice Address - Phone:786-558-5694
Practice Address - Fax:786-913-7034
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-85910106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician