Provider Demographics
NPI:1710432679
Name:FABELO CARMENATES, DIANELLYS
Entity Type:Individual
Prefix:
First Name:DIANELLYS
Middle Name:
Last Name:FABELO CARMENATES
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 1:26218 SW 135TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-2517
Mailing Address - Country:US
Mailing Address - Phone:786-805-2646
Mailing Address - Fax:
Practice Address - Street 1:26218 SW 135TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-2517
Practice Address - Country:US
Practice Address - Phone:786-805-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-124654106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician