Provider Demographics
NPI:1407448228
Name:TABATA, EYLING ANAILET
Entity Type:Individual
Prefix:
First Name:EYLING
Middle Name:ANAILET
Last Name:TABATA
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 1:26500 SW 146TH CT APT 206
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6539
Mailing Address - Country:US
Mailing Address - Phone:407-269-9147
Mailing Address - Fax:
Practice Address - Street 1:26500 SW 146TH CT APT 206
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6539
Practice Address - Country:US
Practice Address - Phone:407-269-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician