Healthcare Provider Details

I. General information

NPI: 1821445560
Provider Name (Legal Business Name): ANGELICA DEL SOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 SW 137TH AVE
MIAMI FL
33175-6330
US

IV. Provider business mailing address

10900 SW 196TH ST APT 122 N
CUTLER BAY FL
33157-8347
US

V. Phone/Fax

Practice location:
  • Phone: 786-832-6630
  • Fax:
Mailing address:
  • Phone: 786-315-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: