Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-10237 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1033657838 |
---|---|
Provider Name | Paola Elizabeth Medina Castillo |
First Address | Miami, FL 33156-7656 |
Second Address | Miami, FL 33156-7656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2017 |
Last Update Date | 01/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019814800 | (05) | FL |