Healthcare Provider Details

I. General information

NPI: 1316612229
Provider Name (Legal Business Name): LAURA MARCELA JARAMILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE STE 206
COCONUT GROVE FL
33133-2740
US

IV. Provider business mailing address

2750 NE 183RD ST APT 2403
AVENTURA FL
33160-2124
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-0112
  • Fax:
Mailing address:
  • Phone: 786-285-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: