Healthcare Provider Details

I. General information

NPI: 1407470776
Provider Name (Legal Business Name): HANNOBER LUIS MOJENA ALMAGUER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11327 SW 164TH ST
MIAMI FL
33157-2711
US

IV. Provider business mailing address

11327 SW 164TH ST
MIAMI FL
33157-2711
US

V. Phone/Fax

Practice location:
  • Phone: 786-630-8649
  • Fax:
Mailing address:
  • Phone: 786-630-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13256
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-121582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: