Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician | FL |
NPI | 1003582412 |
---|---|
Provider Name | Edwina Fernandez |
First Address | Cutler Bay, FL 33189-3450 |
Second Address | Cutler Bay, FL 33189-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 19/08/2021 |