Healthcare Provider Details

I. General information

NPI: 1093482382
Provider Name (Legal Business Name): MRS. AALIYAH J CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 JUBILEE PARK BLVD APT 1326
ORLANDO FL
32822-5229
US

IV. Provider business mailing address

681 BURLINGTON ST
OPA LOCKA FL
33054-3924
US

V. Phone/Fax

Practice location:
  • Phone: 786-630-7903
  • Fax:
Mailing address:
  • Phone: 786-630-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12687310
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: