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Individual

ADA IRIS GUMILA PORTUONDO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
13715 SW 30TH ST, MIAMI, FL 33175-6606
(786) 561-9105
Mailing address
13715 SW 30TH ST, MIAMI, FL 33175-6606
(786) 561-9105

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-322720
FL

Other

Enumeration date
06/07/2024
Last updated
06/07/2024
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