Provider Demographics
NPI:1326881327
Name:BLANCO COLOMBE, DAYNET
Entity type:Individual
Prefix:
First Name:DAYNET
Middle Name:
Last Name:BLANCO COLOMBE
Suffix:
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 1:3945 SW 103RD AVE APT E202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4520
Mailing Address - Country:US
Mailing Address - Phone:813-755-2266
Mailing Address - Fax:
Practice Address - Street 1:3945 SW 103RD AVE APT E202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4520
Practice Address - Country:US
Practice Address - Phone:813-755-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-351694106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician