Healthcare Provider Details

I. General information

NPI: 1891143434
Provider Name (Legal Business Name): ABC OF MIAMI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 TO TO LO CHEE DR
HIALEAH FL
33010-5239
US

IV. Provider business mailing address

321 TO TO LO CHEE DR
HIALEAH FL
33010-5239
US

V. Phone/Fax

Practice location:
  • Phone: 305-773-4037
  • Fax: 305-901-1797
Mailing address:
  • Phone: 305-951-4957
  • Fax: 305-901-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS PEREZ
Title or Position: BCBA/PRESIDENT
Credential:
Phone: 305-773-4037