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General NPI Number Information
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NPI Number | 1245863448
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Entity Type | Organization
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Legal Business Name | SOCIAL DIVERSITY LLC
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Dates
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Enumeration Date | 02/16/2020
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 12001 SW 128TH CT STE 101
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City | MIAMI
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State | FL
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Zip | 33186-4665
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Country | US
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Telephone | 786-975-7485
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Fax |
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Provider Business Mailing Address
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Address Line | 382 NE 19TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33033-5265
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Country | US
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Telephone | 786-975-7485
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ESEL AGUILAR
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Credential | FMD/CBHCMS
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Telephone | 786-975-7485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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