Provider Demographics
NPI:1942846647
Name:BAHAMONDE, ISABELLA (RBT-19-102141)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:BAHAMONDE
Suffix:
Gender:F
Credentials:RBT-19-102141
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15451 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2825
Mailing Address - Country:US
Mailing Address - Phone:786-479-2829
Mailing Address - Fax:
Practice Address - Street 1:15451 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2825
Practice Address - Country:US
Practice Address - Phone:786-479-2829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-102141106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician