Provider Demographics
NPI:1003634759
Name:IZIDOR, DARLINE
Entity type:Individual
Prefix:
First Name:DARLINE
Middle Name:
Last Name:IZIDOR
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 1:14899 NE 18TH AVE APT 4R
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1130
Mailing Address - Country:US
Mailing Address - Phone:754-332-5917
Mailing Address - Fax:
Practice Address - Street 1:14899 NE 18TH AVE APT 4R
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1130
Practice Address - Country:US
Practice Address - Phone:754-332-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-367717106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician