Individual
ANA LAURA BACALLAO DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27767 SW 133RD PL, HOMESTEAD, FL 33032-6854
(305) 842-6037
Mailing address
27767 SW 133RD PL, HOMESTEAD, FL 33032-6854
(305) 842-6037
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-109727
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/08/2020
Last updated
11/06/2020
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