Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003395609 |
---|---|
Provider Name | Eliany Pichardo |
First Address | Hialeah, FL 33016-6520 |
Second Address | Hialeah, FL 33016-6520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018056000 | (05) | FL |