Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-129470 | FL |
NPI | 1003426982 |
---|---|
Provider Name | Judith Lazara Lopez Padilla |
First Address | Miami, FL 33172-4077 |
Second Address | Miami, FL 33172-4077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 05/08/2020 |