Healthcare Provider Details

I. General information

NPI: 1174490791
Provider Name (Legal Business Name): IARA SIMBERE SANT'ANNA RONDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IARA SIMBERE SANT'ANNA

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 NW 85TH CT APT 255
DORAL FL
33122-1987
US

IV. Provider business mailing address

11392 NW 87TH LN
DORAL FL
33178-5616
US

V. Phone/Fax

Practice location:
  • Phone: 301-979-2810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH25907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: