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NPI Code Detail

MEDICARE: ANGELES CHILDREN THERAPY, CORP

MEDICARE: ANGELES CHILDREN THERAPY, CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1295262475
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGELES CHILDREN THERAPY, CORP
Provider Business Mailing Address
First Line : 13055 SW 42ND ST STE 104
Second Line :
City : MIAMI
State : FL
Zip : 33175-3470
Country : US
Telephone Number : 786-360-6125
Fax Number :
Provider Business Practice Location Address
First Line : 13055 SW 42ND ST STE 104
Second Line :
City : MIAMI
State : FL
Zip : 33175-3470
Country : US
Telephone Number : 786-360-6125
Fax Number :
Authorized Official
Title or Position : OWNER
Name : TATIANA BORREGO
Credential :
Telephone Number : 786-360-6125
Provider Enumeration Date : 05/18/2017
Last Update Date : 08/24/2017

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Directions to “ANGELES CHILDREN THERAPY, CORP ” Practice Location

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