Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003326364 |
---|---|
Provider Name | Marietta Hernandez Cabrera |
First Address | Davenport, FL 33897-8556 |
Second Address | Davenport, FL 33897-8556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2017 |
Last Update Date | 01/10/2017 |