Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003331604 |
---|---|
Provider Name | Ileana Delevante Perez |
First Address | Miami, FL 33136-3290 |
Second Address | Miami, FL 33136-3290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 04/08/2017 |