Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 20123525 | FL |
NPI | 1003414475 |
---|---|
Provider Name | Marlen Isabel Martin Menendez |
First Address | Palmetto Bay, FL 33157-5703 |
Second Address | Palmetto Bay, FL 33157-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2020 |
Last Update Date | 16/10/2020 |