Provider Demographics
NPI:1053131318
Name:LEYVA SERRANO, MILTON CARLOS
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:CARLOS
Last Name:LEYVA SERRANO
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 1:2328 10TH AVE N STE 501G
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6615
Mailing Address - Country:US
Mailing Address - Phone:561-719-7283
Mailing Address - Fax:
Practice Address - Street 1:2328 10TH AVE N STE 501G
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6615
Practice Address - Country:US
Practice Address - Phone:561-719-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-381525106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician