Provider Demographics
NPI:1619853777
Name:TRETO, LUIS MANUEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:TRETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13707 KENDALE LAKES CIR APT 316
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2509
Mailing Address - Country:US
Mailing Address - Phone:786-306-5629
Mailing Address - Fax:
Practice Address - Street 1:13707 KENDALE LAKES CIR APT 316
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2509
Practice Address - Country:US
Practice Address - Phone:786-306-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-452559106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician