Healthcare Provider Details

I. General information

NPI: 1194176438
Provider Name (Legal Business Name): LETICIA ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13155 SW 134TH ST STE 115
MIAMI FL
33186-4487
US

IV. Provider business mailing address

13155 SW 134TH ST STE 115
MIAMI FL
33186-4487
US

V. Phone/Fax

Practice location:
  • Phone: 786-429-3738
  • Fax: 305-397-2416
Mailing address:
  • Phone: 786-429-3738
  • Fax: 305-397-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: