Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-16-22972 | FL |
NPI | 1003358003 |
---|---|
Provider Name | Wellington Enrique Vasquez |
First Address | Miramar, FL 33025-7347 |
Second Address | Miramar, FL 33025-7347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-16-22972 | BEHAVIOR ANALYST CERTIFICATION BOARD (01) | FL |