Provider Demographics
NPI:1962263749
Name:MULEN TABLADA, AYREN DIARELIS (RBT-23-286737)
Entity type:Individual
Prefix:MISS
First Name:AYREN
Middle Name:DIARELIS
Last Name:MULEN TABLADA
Suffix:
Gender:F
Credentials:RBT-23-286737
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9050 PINES BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6415
Mailing Address - Country:US
Mailing Address - Phone:954-744-4182
Mailing Address - Fax:954-842-2913
Practice Address - Street 1:9050 PINES BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6415
Practice Address - Country:US
Practice Address - Phone:954-744-4182
Practice Address - Fax:954-842-2913
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-286737106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician