Healthcare Provider Details

I. General information

NPI: 1780986851
Provider Name (Legal Business Name): DEIDANIA VENECIA HENRIQUEZ BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15485 EAGLE NEST LN STE 150
MIAMI LAKES FL
33014-2200
US

IV. Provider business mailing address

15485 EAGLE NEST LN STE 150
MIAMI LAKES FL
33014-2200
US

V. Phone/Fax

Practice location:
  • Phone: 786-534-3457
  • Fax: 305-406-9478
Mailing address:
  • Phone: 305-316-1820
  • Fax: 786-396-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: