Healthcare Provider Details

I. General information

NPI: 1518882067
Provider Name (Legal Business Name): ALYSSA JASMIN AGUILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 SW 160TH AVE STE 401
SUNRISE FL
33326-1905
US

IV. Provider business mailing address

14302 N ROYAL COVE CIR
DAVIE FL
33325-6764
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 954-706-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: