Healthcare Provider Details

I. General information

NPI: 1689169112
Provider Name (Legal Business Name): ROMINA NATALIA DAMORE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 SW 26TH ST # 4
MIAMI FL
33133-2011
US

IV. Provider business mailing address

3674 SW 26TH ST # 4
MIAMI FL
33133-2011
US

V. Phone/Fax

Practice location:
  • Phone: 305-793-0127
  • Fax:
Mailing address:
  • Phone: 305-793-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-58072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: