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General NPI Number Information
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NPI Number | 1912305855
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Entity Type | Individual
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Provider Name | DULCE MATAMOROS MS, CMHP, PHD, BCBA,
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Gender | Female
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 12001 SW 128TH CT SUITE102
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City | MIAMI
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State | FL
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Zip | 33186-4664
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Country | US
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Telephone | 786-429-1225
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Fax | 305-602-5987
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Provider Business Mailing Address
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Address Line | 15969 NW 64TH AVE APT402
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City | MIAMI LAKES
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State | FL
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Zip | 33014-5596
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Country | US
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Telephone | 786-429-1225
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Fax | 305-602-5987
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | $$$$$$$$$
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License Number State | FL
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