Healthcare Provider Details

I. General information

NPI: 1538580378
Provider Name (Legal Business Name): MS. ALEXANDRA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8123 W 36TH AVE APT 5
HIALEAH FL
33018-1823
US

IV. Provider business mailing address

8123 W 36TH AVE APT 5
HIALEAH FL
33018-1823
US

V. Phone/Fax

Practice location:
  • Phone: 305-303-9032
  • Fax:
Mailing address:
  • Phone: 305-303-9032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH-19260
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number118560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: