Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | 0-18-9178 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1003358052 |
---|---|
Provider Name | Ileana Regalado Hernandez |
First Address | Miramar, FL 33025-2717 |
Second Address | Miramar, FL 33025-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 25/10/2021 |