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General NPI Number Information
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NPI Number | 1124849393
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Entity Type | Individual
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Provider Name | NICOLE MAZO ROA
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 13155 SW 134TH ST STE 207
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City | MIAMI
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State | FL
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Zip | 33186-4488
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Country | US
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Telephone | 786-842-3624
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Fax |
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Provider Business Mailing Address
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Address Line | 8760 SW 133RD AVE APT 313
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City | MIAMI
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State | FL
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Zip | 33183-5375
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Country | US
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Telephone | 786-484-4317
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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 | RBT-24-386313
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License Number State | FL
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