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General NPI Number Information
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NPI Number | 1033923529
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Entity Type | Individual
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Provider Name | MICAELA ILIANA LENI LARRALDE
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 160 NW 176TH ST STE 344
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5049
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Country | US
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Telephone | 305-816-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 401 69TH ST APT 812
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City | MIAMI BEACH
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State | FL
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Zip | 33141-3124
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Country | US
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Telephone | 832-610-6711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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