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General NPI Number Information
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NPI Number | 1780348037
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Entity Type | Individual
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Provider Name | DANAIRIS FONTE LAGO RBT
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Gender | Female
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 5820 N CHURCH AVE UNIT 121
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City | TAMPA
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State | FL
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Zip | 33614-5640
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Country | US
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Telephone | 813-820-2314
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Fax |
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Provider Business Mailing Address
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Address Line | 6913 N LOIS AVE
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City | TAMPA
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State | FL
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Zip | 33614-3855
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Country | US
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Telephone | 786-328-5064
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | RBT-21-189803
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License Number State | FL
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