Healthcare Provider Details

I. General information

NPI: 1659196665
Provider Name (Legal Business Name): CARMEN ROSA AZNARAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAWGRASS CORPORATE PKWY STE 106
SUNRISE FL
33325-6236
US

IV. Provider business mailing address

1279 NE 181ST ST
NORTH MIAMI BEACH FL
33162-1325
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-1112
  • Fax: 954-745-1120
Mailing address:
  • Phone: 305-409-7550
  • 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: