Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-16427 | FL |
NPI | 1003219908 |
---|---|
Provider Name | Malena Suarez Martinez |
First Address | Weston, FL 33331-3622 |
Second Address | Weston, FL 33331-3622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010060900 | (05) | FL |