Provider Demographics
NPI:1316553902
Name:PUPO, DAMIANA DEL CARMEN
Entity type:Individual
Prefix:
First Name:DAMIANA
Middle Name:DEL CARMEN
Last Name:PUPO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 W 22ND LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3963
Mailing Address - Country:US
Mailing Address - Phone:786-623-1716
Mailing Address - Fax:
Practice Address - Street 1:6580 W 22ND LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3963
Practice Address - Country:US
Practice Address - Phone:786-623-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL02516032106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician