Provider Demographics
NPI:1669004636
Name:FLORENCIO, FABIOLA MARQUES
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:MARQUES
Last Name:FLORENCIO
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 1:731 MALL RING CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6691
Mailing Address - Country:US
Mailing Address - Phone:719-287-0212
Mailing Address - Fax:
Practice Address - Street 1:731 MALL RING CIR STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6691
Practice Address - Country:US
Practice Address - Phone:719-287-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-20-111865106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician