Healthcare Provider Details

I. General information

NPI: 1356852537
Provider Name (Legal Business Name): DAYALIN IZQUIERDO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2947 COCONUT AVE APT 2
CORAL GABLES FL
33133-3790
US

IV. Provider business mailing address

3570 ALTIS CIR N UNIT 9105
HIALEAH FL
33018-6081
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-1840
  • Fax:
Mailing address:
  • Phone: 305-778-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56236
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: