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General NPI Number Information
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NPI Number | 1215577242
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Entity Type | Individual
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Provider Name | IVONNE MICHELLE AYALA PEREZ RBT
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 03/28/2021
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Provider Practice Location Address
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Address Line | 4355 FOUNTAINVIEW LN APT 7101
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City | ORLANDO
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State | FL
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Zip | 32808-5707
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Country | US
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Telephone | 484-425-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 4355 FOUNTAINVIEW LN APT 7101
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City | ORLANDO
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State | FL
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Zip | 32808-5707
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Country | US
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Telephone | 484-425-3150
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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 | A416413965960
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License Number State | FL
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