Healthcare Provider Details

I. General information

NPI: 1609734896
Provider Name (Legal Business Name): ELEANI PADRON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 NW 12TH ST STE 408
DORAL FL
33126-1892
US

IV. Provider business mailing address

910 W 64TH ST
HIALEAH FL
33012-6415
US

V. Phone/Fax

Practice location:
  • Phone: 877-270-0707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: