Provider Demographics
NPI:1417705906
Name:UTRIA MATOS, FRANKLIN
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:
Last Name:UTRIA MATOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SW 122ND AVE APT 318
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7351
Mailing Address - Country:US
Mailing Address - Phone:973-650-9529
Mailing Address - Fax:
Practice Address - Street 1:1950 SW 122ND AVE APT 318
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7351
Practice Address - Country:US
Practice Address - Phone:973-650-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-345008106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician