=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023762820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED SUPPORT SOLUTIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2022
-----------------------------------------------------
Last Update Date | 02/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11117 SW 134TH PL
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-380-6840
-----------------------------------------------------
Fax | 305-383-7055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11117 SW 134TH PL
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-380-6840
-----------------------------------------------------
Fax | 305-383-7055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | WSC
-----------------------------------------------------
Name | CRISTIANA ROBAINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-587-4522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------