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General NPI Number Information
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NPI Number | 1366283236
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Entity Type | Individual
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Provider Name | MADILEIDY LAGOA ORTEGA SR.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 1700 SW 127TH CT
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City | MIAMI
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State | FL
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Zip | 33175-1252
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Country | US
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Telephone | 305-337-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 SW 127TH CT
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City | MIAMI
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State | FL
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Zip | 33175-1252
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Country | US
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Telephone | 305-337-8920
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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-24-351-1182
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License Number State | FL
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