Healthcare Provider Details

I. General information

NPI: 1811507056
Provider Name (Legal Business Name): ALETHEA KOHILAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAIRWAY DR STE 102
DEERFIELD BEACH FL
33441-1817
US

IV. Provider business mailing address

1918 MARAIS ST
NEW ORLEANS LA
70116-1524
US

V. Phone/Fax

Practice location:
  • Phone: 855-550-5380
  • Fax:
Mailing address:
  • Phone: 516-351-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: