Basic Information
| Provider Information | |||||||||
| NPI: | 1790398691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELTORO | ||||||||
| FirstName: | TATIANA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8001 SW 36TH ST STE 9 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333281915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545777790 | ||||||||
| FaxNumber: | 9545777780 | ||||||||
| Practice Location | |||||||||
| Address1: | 824 S LAKE DR | ||||||||
| Address2: | |||||||||
| City: | LANTANA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334624626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614607148 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.