Provider Demographics
NPI:1124767389
Name:TALON ZAMORA, MADAYANLIS (RBT-20-145153)
Entity type:Individual
Prefix:
First Name:MADAYANLIS
Middle Name:
Last Name:TALON ZAMORA
Suffix:
Gender:F
Credentials:RBT-20-145153
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 NW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-8541
Mailing Address - Country:US
Mailing Address - Phone:239-245-0824
Mailing Address - Fax:
Practice Address - Street 1:2513 NW 15TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-8541
Practice Address - Country:US
Practice Address - Phone:239-245-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-145153106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician