Healthcare Provider Details

I. General information

NPI: 1033708359
Provider Name (Legal Business Name): LOURDES PORTUONDO PALOMINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 NW 10TH ST APT 1
FLORIDA CITY FL
33034-1917
US

IV. Provider business mailing address

957 NW 10TH ST APT 1
FLORIDA CITY FL
33034-1917
US

V. Phone/Fax

Practice location:
  • Phone: 786-343-9780
  • Fax:
Mailing address:
  • Phone: 786-343-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90160
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-145278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: