Provider Demographics
NPI:1235900697
Name:FUNDORA LLERENA, DARIAN
Entity Type:Individual
Prefix:
First Name:DARIAN
Middle Name:
Last Name:FUNDORA LLERENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 10TH AVE N APT 135
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-1627
Mailing Address - Country:US
Mailing Address - Phone:561-889-0353
Mailing Address - Fax:
Practice Address - Street 1:6051 10TH AVE N APT 135
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-1627
Practice Address - Country:US
Practice Address - Phone:561-889-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-315584106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician