Healthcare Provider Details

I. General information

NPI: 1881371235
Provider Name (Legal Business Name): KEREN ALONSO SALCEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 W 53RD PL
HIALEAH FL
33016-2020
US

IV. Provider business mailing address

2309 W 53RD PL
HIALEAH FL
33016-2020
US

V. Phone/Fax

Practice location:
  • Phone: 786-812-4375
  • Fax:
Mailing address:
  • Phone: 786-812-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: