Provider Demographics
NPI:1164293411
Name:MOMPELLER, ENRIQUE JOSE (RBT-24-319831)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JOSE
Last Name:MOMPELLER
Suffix:
Gender:M
Credentials:RBT-24-319831
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10789 SW 4TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1457
Mailing Address - Country:US
Mailing Address - Phone:305-842-7692
Mailing Address - Fax:
Practice Address - Street 1:10789 SW 4TH ST APT 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1457
Practice Address - Country:US
Practice Address - Phone:305-842-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-319831106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician