Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 106E00000X | Assistant Behavior Analyst | 0-17-8402 | FL |
NPI | 1104277789 |
---|---|
Provider Name | Bryan Nanez |
First Address | Sunrise, FL 33325-6244 |
Second Address | Sunrise, FL 33325-6244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2016 |
Last Update Date | 14/04/2019 |