Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-9522 | FL |
NPI | 1164084992 |
---|---|
Provider Name | Mrs. Maylen Soris Roca |
First Address | Miami, FL 33172-4089 |
Second Address | Miami, FL 33172-4082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 02/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022296100 | (05) | FL |