Healthcare Provider Details

I. General information

NPI: 1003447871
Provider Name (Legal Business Name): ANORANZA DE MI VIEJO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 W FLAGLER ST
MIAMI FL
33135-1939
US

IV. Provider business mailing address

1849 W FLAGLER ST
MIAMI FL
33135-1939
US

V. Phone/Fax

Practice location:
  • Phone: 786-278-7190
  • Fax:
Mailing address:
  • Phone: 954-225-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YORDAN SENAN BENITEZ
Title or Position: PRESIDENT
Credential:
Phone: 954-225-0199