Provider Demographics
NPI:1760844112
Name:MUNOZ, FABIOLA BEATRIZ (BCBA)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:BEATRIZ
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 NW 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2212
Mailing Address - Country:US
Mailing Address - Phone:954-554-2447
Mailing Address - Fax:
Practice Address - Street 1:2354 NW 39TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2212
Practice Address - Country:US
Practice Address - Phone:954-554-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-1746103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst