=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629806526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANYS MILDREY AYALA ALFONSO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2024
-----------------------------------------------------
Last Update Date | 07/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 790 NW 107TH AVE STE 110
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-964-5426
-----------------------------------------------------
Fax | 305-964-5624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8306 SW 157TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-5242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-502-7980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------