Healthcare Provider Details

I. General information

NPI: 1679851497
Provider Name (Legal Business Name): ANA-KRISTINA AGUERO M.S-CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 VAN BUREN ST
HOLLYWOOD FL
33020-5127
US

IV. Provider business mailing address

2925 NW 126TH AVE APT 311
SUNRISE FL
33323-6322
US

V. Phone/Fax

Practice location:
  • Phone: 954-920-9000
  • Fax:
Mailing address:
  • Phone: 786-385-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106697
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: