Healthcare Provider Details

I. General information

NPI: 1790658144
Provider Name (Legal Business Name): LEGNA PETITON CARRION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 10/24/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 W 19TH AVE APT 215
HIALEAH FL
33012-6075
US

IV. Provider business mailing address

6190 W 19TH AVE APT 215
HIALEAH FL
33012-6075
US

V. Phone/Fax

Practice location:
  • Phone: 786-992-4487
  • Fax:
Mailing address:
  • Phone: 786-992-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: