Individual
ANA A PORTAL PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14103 EASTLAND LN, TAMPA, FL 33625-6410
(813) 410-0766
Mailing address
14103 EASTLAND LN, TAMPA, FL 33625-6410
(813) 410-0766
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-224230
FL
Other
Enumeration date
07/25/2022
Last updated
07/25/2022
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