Healthcare Provider Details

I. General information

NPI: 1245140102
Provider Name (Legal Business Name): ANTONIO ALVES DE SOUZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 W 20TH AVE
HIALEAH FL
33012-5874
US

IV. Provider business mailing address

7601 E TREASURE DR APT 1207
NORTH BAY VILLAGE FL
33141-4363
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-0300
  • Fax:
Mailing address:
  • Phone: 305-766-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: