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General NPI Number Information
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NPI Number | 1093437931
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Entity Type | Individual
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Provider Name | LIDIBETH BRAVO AGUILERA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 7875 NW 12TH ST STE 110
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City | DORAL
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State | FL
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Zip | 33126-1815
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Country | US
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Telephone | 786-835-8836
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Fax |
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Provider Business Mailing Address
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Address Line | 11409 SW 45TH CT UNIT 110
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City | MIRAMAR
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State | FL
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Zip | 33025-7897
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Country | US
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Telephone | 786-835-8836
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 22-231922
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License Number State | FL
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