Provider Demographics
NPI:1689384208
Name:DE LA FUENTE BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:DE LA FUENTE BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA FUENTE ZABALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-366-6145
Mailing Address - Street 1:8365 SW 152ND AVE APT C-115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4028
Mailing Address - Country:US
Mailing Address - Phone:786-366-6145
Mailing Address - Fax:
Practice Address - Street 1:8365 SW 152ND AVE APT C-115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-4028
Practice Address - Country:US
Practice Address - Phone:786-366-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty