Individual
CAMILO ISAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
147 PRINCE ST, BROOKLYN, NY 11201-3022
(704) 536-2958
Mailing address
147 PRINCE ST, BROOKLYN, NY 11201-3022
(718) 536-2958
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S
—
FL
Enumeration date
11/08/2018
Last updated
09/27/2021
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