Provider Demographics
NPI:1346995420
Name:SELGADO, PALOMA (RBT)
Entity Type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:SELGADO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7534 TUSCAN BAY CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4910
Mailing Address - Country:US
Mailing Address - Phone:313-407-2691
Mailing Address - Fax:
Practice Address - Street 1:10817 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3616
Practice Address - Country:US
Practice Address - Phone:866-311-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician