Provider Demographics
NPI:1164173043
Name:DA LAMA FUENTES, DANIA
Entity Type:Individual
Prefix:
First Name:DANIA
Middle Name:
Last Name:DA LAMA FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26100 SW 144TH AVENUE RD APT 311
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7441
Mailing Address - Country:US
Mailing Address - Phone:786-515-4199
Mailing Address - Fax:
Practice Address - Street 1:26100 SW 144TH AVENUE RD APT 311
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7441
Practice Address - Country:US
Practice Address - Phone:786-515-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-174257106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician