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General NPI Number Information
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NPI Number | 1528829058
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Entity Type | Organization
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Legal Business Name | ANGELS OF LIFE THERAPY INC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 5785A NW 151ST ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2490
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Country | US
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Telephone | 786-817-3599
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Fax | 786-360-3166
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Provider Business Mailing Address
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Address Line | 5785A NW 151ST ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2490
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Country | US
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Telephone | 786-817-3599
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Fax | 786-360-3166
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. YASSET DOMINGUEZ LEON
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Credential |
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Telephone | 786-671-9239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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