Healthcare Provider Details

I. General information

NPI: 1154156750
Provider Name (Legal Business Name): DDJ SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12985 SW 130TH CT UNIT 101
MIAMI FL
33186-5344
US

IV. Provider business mailing address

12985 SW 130TH CT UNIT 101
MIAMI FL
33186-5344
US

V. Phone/Fax

Practice location:
  • Phone: 786-205-0090
  • Fax:
Mailing address:
  • Phone: 786-205-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YALIANA COLUMBIE PRADO
Title or Position: OWNER
Credential:
Phone: 786-205-0090