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General NPI Number Information
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NPI Number | 1225544604
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Entity Type | Organization
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Legal Business Name | I ROCK BEHAVIOR LLC
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 18480 NW 19TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3823
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Country | US
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Telephone | 786-376-5812
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Fax |
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Provider Business Mailing Address
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Address Line | 18480 NW 19TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3823
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Country | US
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Telephone | 786-376-5812
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MALENA S MARTINEZ
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Credential | MS, BCBA
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Telephone | 786-376-5812
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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 |
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License Number State | FL
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