Healthcare Provider Details

I. General information

NPI: 1598230872
Provider Name (Legal Business Name): MILAGRO DAAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 LENOX AVE
MIAMI BEACH FL
33139-6532
US

IV. Provider business mailing address

PO BOX 12618
MIAMI FL
33101-2618
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-1924
  • Fax:
Mailing address:
  • Phone: 305-767-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-64558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: