Healthcare Provider Details

I. General information

NPI: 1982425443
Provider Name (Legal Business Name): AISA FLEITES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 SW 186TH ST STE 306
CUTLER BAY FL
33157-6843
US

IV. Provider business mailing address

3822 SW 95TH AVE
MIAMI FL
33165-4028
US

V. Phone/Fax

Practice location:
  • Phone: 786-224-6884
  • Fax: 786-688-2483
Mailing address:
  • Phone: 786-219-9229
  • 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: