=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629551841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEJANDRA ANZOLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2018
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2866 E OAKLAND PARK BLVD STE 2
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33306-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-561-6900
-----------------------------------------------------
Fax | 833-687-1445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6255 W SUNSET BLVD FL 21
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-7422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-860-5200
-----------------------------------------------------
Fax | 323-467-7119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 19149
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------