Provider Demographics
NPI:1790480168
Name:TRIUMPH ABA LLC
Entity Type:Organization
Organization Name:TRIUMPH ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MURSULI LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-223-7310
Mailing Address - Street 1:12485 SW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2602
Mailing Address - Country:US
Mailing Address - Phone:786-223-7310
Mailing Address - Fax:
Practice Address - Street 1:12485 SW 9TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2602
Practice Address - Country:US
Practice Address - Phone:786-223-7310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty