Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-126004 | FL |
NPI | 1003413626 |
---|---|
Provider Name | Elier Lavandera |
First Address | Homestead, FL 33033-2992 |
Second Address | Homestead, FL 33033-2992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2020 |
Last Update Date | 06/10/2020 |