Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-21-153423 | FL |
NPI | 1003400052 |
---|---|
Provider Name | Crystal Michelle Valdeon Mantilla |
First Address | Miami, FL 33172-4573 |
Second Address | Miami, FL 33172-4573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2021 |
Last Update Date | 25/03/2021 |