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General NPI Number Information
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NPI Number | 1851756464
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Entity Type | Individual
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Provider Name | MS. IRIS ALTAGRACIA MOLINA MUTIZ
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Gender | Female
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Dates
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Enumeration Date | 12/24/2015
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 7473 SW 82ND ST APT A312
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City | MIAMI
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State | FL
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Zip | 33143-7353
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Country | US
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Telephone | 786-867-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 7815 SW 88TH ST APT E326
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City | MIAMI
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State | FL
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Zip | 33156-7729
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Country | US
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Telephone | 305-606-6195
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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 | 0-19-9759
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-60572
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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