Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-117673 | FL |
NPI | 1003267139 |
---|---|
Provider Name | Yadilux Gonzalez Cancio |
First Address | Hialeah, FL 33015-3652 |
Second Address | Hialeah, FL 33015-3652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 13/05/2020 |