Provider Demographics
NPI:1730714510
Name:FRONTELA FERNANDEZ, AILYN (BCBA)
Entity type:Individual
Prefix:MS
First Name:AILYN
Middle Name:
Last Name:FRONTELA FERNANDEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13563 SW 255TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6828
Mailing Address - Country:US
Mailing Address - Phone:786-603-7970
Mailing Address - Fax:
Practice Address - Street 1:18901 SW 106TH AVE STE A227
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7661
Practice Address - Country:US
Practice Address - Phone:786-732-7516
Practice Address - Fax:786-732-7718
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-10885106E00000X
FL1-21-50562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst