Provider Demographics
NPI:1821845421
Name:TRUJILLO FLORES, TAHIS MILEHIDY
Entity type:Individual
Prefix:
First Name:TAHIS
Middle Name:MILEHIDY
Last Name:TRUJILLO FLORES
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 1:108 NW 9TH TER APT 309
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3954
Mailing Address - Country:US
Mailing Address - Phone:786-599-2335
Mailing Address - Fax:
Practice Address - Street 1:108 NW 9TH TER APT 309
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3954
Practice Address - Country:US
Practice Address - Phone:786-599-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-339368106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician