=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376421842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAOLA ANDREA ASTUDILLO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2025
-----------------------------------------------------
Last Update Date | 08/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9410 TANGERINE PL APT 403
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-701-4987
-----------------------------------------------------
Fax | 855-532-9272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1836 ARTHUR ST APT 16
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-759-9004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1000229
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------