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General NPI Number Information
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NPI Number | 1538824545
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Entity Type | Organization
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Legal Business Name | EARLY INTERVENTION PROGRAM LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 3625 NW 82ND AVE STE N
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City | DORAL
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State | FL
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Zip | 33166-6652
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Country | US
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Telephone | 786-615-2890
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Fax | 305-381-5119
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Provider Business Mailing Address
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Address Line | 3625 NW 82ND AVE STE ZZ
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City | DORAL
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State | FL
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Zip | 33166-6652
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Country | US
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Telephone | 786-643-7819
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANGELA TEJEDA
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Credential |
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Telephone | 786-643-7819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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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