Provider Demographics
NPI:1124823562
Name:FERNANDEZ SOTOLONGO, MAYA (RBT)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:FERNANDEZ SOTOLONGO
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12871 SW 242ND ST APT 3204
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3183
Mailing Address - Country:US
Mailing Address - Phone:623-850-6927
Mailing Address - Fax:
Practice Address - Street 1:12871 SW 242ND ST APT 3204
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3183
Practice Address - Country:US
Practice Address - Phone:623-850-6927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-402102106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician