Healthcare Provider Details

I. General information

NPI: 1942839675
Provider Name (Legal Business Name): ABIA ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 NW 98TH PL
DORAL FL
33178-1928
US

IV. Provider business mailing address

4820 NW 98TH PL
DORAL FL
33178-1928
US

V. Phone/Fax

Practice location:
  • Phone: 305-342-2481
  • Fax:
Mailing address:
  • Phone: 305-342-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALIETTE NEYRA
Title or Position: MANAGER
Credential:
Phone: 305-342-2481