Healthcare Provider Details

I. General information

NPI: 1669376935
Provider Name (Legal Business Name): JHANNY DAYANA MADRIGAL SAN BLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26715 SW 140TH AVE UNIT 212
HOMESTEAD FL
33032-8420
US

IV. Provider business mailing address

26715 SW 140TH AVE UNIT 212
HOMESTEAD FL
33032-8420
US

V. Phone/Fax

Practice location:
  • Phone: 239-380-4294
  • Fax:
Mailing address:
  • Phone: 239-380-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number125603200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: