Healthcare Provider Details

I. General information

NPI: 1306130141
Provider Name (Legal Business Name): DEBBIE RAYGADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12051 W OKEECHOBEE RD
HIALEAH GARDENS FL
33018-2933
US

IV. Provider business mailing address

12051 W OKEECHOBEE RD
HIALEAH GARDENS FL
33018
US

V. Phone/Fax

Practice location:
  • Phone: 305-332-3421
  • Fax:
Mailing address:
  • Phone: 305-332-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: