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General NPI Number Information
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NPI Number | 1104580588
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Entity Type | Individual
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Provider Name | LISSET YOLANDA TEMES PARRAGA
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Gender | Female
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 8461 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-2474
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Country | US
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Telephone | 561-315-4170
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 SPRINGDALE BLVD APT Y217
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City | PALM SPRINGS
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State | FL
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Zip | 33461-6368
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Country | US
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Telephone | 561-229-7164
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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 |
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License Number State | FL
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