Healthcare Provider Details

I. General information

NPI: 1659719821
Provider Name (Legal Business Name): AG THERAPEUTIC SERVICES, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11380 SW 113TH TER
MIAMI FL
33176-3829
US

IV. Provider business mailing address

11380 SW 113TH TER
MIAMI FL
33176-3829
US

V. Phone/Fax

Practice location:
  • Phone: 786-426-7570
  • Fax: 305-742-2753
Mailing address:
  • Phone: 786-426-7570
  • Fax: 305-742-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA BIBIANA GONZALEZ
Title or Position: PRESIDENT
Credential: PT
Phone: 786-426-7570