Provider Demographics
NPI:1598537888
Name:NADALES PAEZ, DANIEL ALEJANDRO
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEJANDRO
Last Name:NADALES PAEZ
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 1:11430 NW 75TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2249
Mailing Address - Country:US
Mailing Address - Phone:786-874-4641
Mailing Address - Fax:
Practice Address - Street 1:11430 NW 75TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2249
Practice Address - Country:US
Practice Address - Phone:786-874-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician