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General NPI Number Information
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NPI Number | 1104596105
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Entity Type | Organization
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Legal Business Name | D AND L COMMUNITY SUPPORT LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 2400 SW 137TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6311
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Country | US
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Telephone | 305-456-0572
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Fax | 786-980-5700
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Provider Business Mailing Address
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Address Line | 2400 SW 137TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6311
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Country | US
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Telephone | 305-456-0572
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Fax | 786-980-5700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DORGIS GONZALEZ REINOSO
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Credential |
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Telephone | 786-424-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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