Provider Demographics
NPI:1871364117
Name:MIRANDA BOZA, MIRNA DE LA CARIDAD (RBT)
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:DE LA CARIDAD
Last Name:MIRANDA BOZA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 WINKLER AVE APT 1324
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9444
Mailing Address - Country:US
Mailing Address - Phone:239-373-9186
Mailing Address - Fax:
Practice Address - Street 1:3665 WINKLER AVE APT 1324
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9444
Practice Address - Country:US
Practice Address - Phone:305-910-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
RBT-23-296983106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician