=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346065992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEST ABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2024
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11478 SW 237TH TER
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-7132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-323-8077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11478 SW 237TH TER
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-7132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-323-8077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAYLEN GOMEZ GARCIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 551-323-8077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------