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General NPI Number Information
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NPI Number | 1326333634
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Entity Type | Organization
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Legal Business Name | ILLUMINATING LIVES CORP
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 11510 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33173-3603
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Country | US
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Telephone | 786-282-9935
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Fax |
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Provider Business Mailing Address
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Address Line | 11510 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33173-3603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ROSARIO VALLADARES
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Credential |
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Telephone | 786-200-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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