Healthcare Provider Details

I. General information

NPI: 1538656632
Provider Name (Legal Business Name): ANGIE YESENIA FALLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 SW 40TH ST STE 309
MIAMI FL
33165-3339
US

IV. Provider business mailing address

6789 SW 14TH ST
MIAMI FL
33144-5528
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-1669
  • Fax:
Mailing address:
  • Phone: 786-606-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: