Healthcare Provider Details

I. General information

NPI: 1477374189
Provider Name (Legal Business Name): SMILING KIDZ PPEC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 SHERIDAN ST
HOLLYWOOD FL
33021-3513
US

IV. Provider business mailing address

4415 SHERIDAN ST
HOLLYWOOD FL
33021-3513
US

V. Phone/Fax

Practice location:
  • Phone: 954-394-2663
  • Fax:
Mailing address:
  • Phone: 954-394-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YILIEN LARACUENTE
Title or Position: OWNER, SMILING KIDZ PPEC LLC
Credential:
Phone: 954-394-2663