Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-13023 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1154898443 |
---|---|
Provider Name | Leslie Fernandez |
First Address | Doral, FL 33172-1416 |
Second Address | Doral, FL 33172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 30/11/2021 |