Healthcare Provider Details

I. General information

NPI: 1033083662
Provider Name (Legal Business Name): MAGNOLIA THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW 107TH AVE STE 205
MIAMI FL
33174-3602
US

IV. Provider business mailing address

300 SW 107TH AVE STE 205
MIAMI FL
33174-3602
US

V. Phone/Fax

Practice location:
  • Phone: 305-209-0038
  • Fax: 305-675-7767
Mailing address:
  • Phone: 305-209-0038
  • Fax: 305-675-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LILIANA GALVEZ ALONSO
Title or Position: AMBR
Credential:
Phone: 305-209-0038