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Provider Information for 1881239754

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1881239754

Calendar   Last Updated:  2019-11-14
  Certification Date: 


Name Value
NPI 1881239754
Enumeration Date 2019-11-14
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 26760 SW 142ND AVE APT 204
NARANJA, FL 33032-5416
United States

Phone: 314-406-1586 | Fax:
View Map External Link
Primary Practice Address 1180 N KROME AVE
HOMESTEAD, FL 33030-4413
United States

Phone: 786-349-4700 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 106S00000X - Behavior Technician