=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972449882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROMORA BEHAVIORAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2026
-----------------------------------------------------
Last Update Date | 04/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9823 7TH AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32824-7255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-715-2995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9823 7TH AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32824-7255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-715-2995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIZ MERARI VEGA MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-715-2995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------