Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003313354 |
---|---|
Provider Name | Marlon Manuel Guanes |
First Address | Hialeah, FL 33012-6767 |
Second Address | Hialeah, FL 33012-6767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 11/04/2018 |