Provider Demographics
NPI:1063185395
Name:ARCE, ILIANA I
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:ARCE
Suffix:I
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 1:16205 SW 275 ST HOMESTEAD FL 33031
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031
Mailing Address - Country:US
Mailing Address - Phone:786-909-8090
Mailing Address - Fax:
Practice Address - Street 1:16205 SW 275 ST HOMESTEAD FL 33031
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33031
Practice Address - Country:US
Practice Address - Phone:786-909-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-132250106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-132250OtherREGISTERED BEHAVIOR TECHNICIAN