Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053963496 |
---|---|
Provider Name | Ana M Lastres Dorta |
First Address | Miami, FL 33125-1852 |
Second Address | Miami, FL 33125-1852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 16/07/2019 |