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General NPI Number Information
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NPI Number | 1528820487
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Entity Type | Individual
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Provider Name | MALIAH ARIEL FORTES
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 18288 N US HIGHWAY 41
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City | LUTZ
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State | FL
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Zip | 33549-4400
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Country | US
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Telephone | 813-527-9638
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 LOCHMONT DR
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City | BRANDON
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State | FL
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Zip | 33511-6264
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Country | US
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Telephone | 727-385-2863
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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-24-323826
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License Number State |
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