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General NPI Number Information
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NPI Number | 1114473337
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Entity Type | Individual
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Provider Name | ILEANA PAEZ
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 6447 MIAMI LAKES DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2741
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Country | US
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Telephone | 305-310-2838
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Fax |
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Provider Business Mailing Address
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Address Line | 3885 W 9TH CT
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City | HIALEAH
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State | FL
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Zip | 33012-7227
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Country | US
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Telephone | 786-424-5877
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-15-05789
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-15-05789
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License Number State | FL
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