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General NPI Number Information
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NPI Number | 1538921069
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Entity Type | Individual
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Provider Name | AILEN AGOSTINA LEGUIZAMON
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 111 NW 183RD ST STE 404
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City | MIAMI
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State | FL
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Zip | 33169-4619
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Country | US
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Telephone | 786-708-2286
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Fax |
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Provider Business Mailing Address
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Address Line | 13195 SW 9TH TER
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City | MIAMI
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State | FL
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Zip | 33184-2021
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Country | US
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Telephone | 786-218-9824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW19191
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License Number State | FL
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