Healthcare Provider Details

I. General information

NPI: 1669004636
Provider Name (Legal Business Name): FABIOLA MARQUES FLORENCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 MALL RING CIR STE 202
HENDERSON NV
89014-6691
US

IV. Provider business mailing address

731 MALL RING CIR STE 202
HENDERSON NV
89014-6691
US

V. Phone/Fax

Practice location:
  • Phone: 719-287-0212
  • Fax:
Mailing address:
  • Phone: 719-287-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-111865
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: