Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0199838 | |
N | 106S00000X | Behavior Technician | FL |
NPI | 1134621303 |
---|---|
Provider Name | Boris Leyva Lopez |
First Address | Miami, FL 33186-1604 |
Second Address | Homestead, FL 33035-1173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2018 |
Last Update Date | 21/11/2019 |