=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235950478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISABELLA FERNANDA LONDONDO RAIOLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 SW 129TH PL APT 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-2169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-765-9170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 SW 129TH PL APT 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-2169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-765-9170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | L535406016360
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------