Individual
INDIOMI PENG SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1476 N HOMESTEAD BLVD, HOMESTEAD, FL 33030-5008
(786) 339-8524
Mailing address
3764 NE 1ST ST, HOMESTEAD, FL 33033-7465
(786) 586-2981
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-23-272338
FL
2355S0801X
Speech-Language Assistant
Primary
SI6787
FL
Other
Enumeration date
12/04/2023
Last updated
12/09/2023
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