Individual
ILEANA QUEVEDO DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4815 LIST DR STE 107, COLORADO SPRINGS, CO 80919-3340
(719) 224-7108
Mailing address
4815 LIST DR STE 107, COLORADO SPRINGS, CO 80919-3340
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-385775
CO
Other
Enumeration date
10/18/2024
Last updated
10/18/2024
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