Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0-05-1976 | FL |
NPI | 1003110768 |
---|---|
Provider Name | Ms. Georgina Valazza |
First Address | Davie, FL 33328-1915 |
Second Address | Davie, FL 33328-2001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 10/01/2011 |