Provider Demographics
NPI:1942184650
Name:LAGUNA SALVIA, LEONARDO
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:LAGUNA SALVIA
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 1:9163 NW 147TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7303
Mailing Address - Country:US
Mailing Address - Phone:786-304-8335
Mailing Address - Fax:
Practice Address - Street 1:230 W DEL MONTE AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-5204
Practice Address - Country:US
Practice Address - Phone:305-803-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-459959106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician