Provider Demographics
NPI:1891482147
Name:DEL RISCO FUENTES, ALINA
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:DEL RISCO FUENTES
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 1:1650 W 44TH PL APT 223
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7469
Mailing Address - Country:US
Mailing Address - Phone:786-574-1276
Mailing Address - Fax:
Practice Address - Street 1:1650 W 44TH PL APT 223
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7469
Practice Address - Country:US
Practice Address - Phone:786-574-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst