Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 18-56869 | FL |
NPI | 1114583960 |
---|---|
Provider Name | Dalila Perez Lopez |
First Address | Hialeah, FL 33014-4604 |
Second Address | Hialeah, FL 33014-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2019 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P620160857450 | (05) | FL |