Provider Demographics
NPI:1952952673
Name:DEHELEAN PUPAZA, NATALIE (RBT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DEHELEAN PUPAZA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 W STATE ROAD 84 UNIT 205
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-8809
Mailing Address - Country:US
Mailing Address - Phone:503-387-9953
Mailing Address - Fax:
Practice Address - Street 1:11011 SHERIDAN ST STE 210
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1531
Practice Address - Country:US
Practice Address - Phone:954-552-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-208990106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-22-208990OtherBACB