Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003303348 |
---|---|
Provider Name | Rosa Aurora Molina |
First Address | Homestead, FL 33032-8518 |
Second Address | Homestead, FL 33032-8518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2018 |
Last Update Date | 20/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022383900 | (05) | FL |