Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1093312647 |
---|---|
Provider Name | Rody Blanco |
First Address | Tampa, FL 33647-1823 |
Second Address | Tampa, FL 33647-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 18/11/2020 |