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General NPI Number Information
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NPI Number | 1831861020
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Entity Type | Organization
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Legal Business Name | LAS TIAS ALL INSURANCE CORP
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 2000 NW 89TH PL STE 120
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City | DORAL
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State | FL
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Zip | 33172-2618
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Country | US
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Telephone | 786-877-3194
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Fax | 954-337-0778
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Provider Business Mailing Address
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Address Line | 9766 NW 47TH TER
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City | DORAL
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State | FL
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Zip | 33178-1960
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Country | US
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Telephone | 786-877-3194
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Fax | 786-869-2106
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIDA AGUILAR
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Credential | PRESIDENT
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Telephone | 786-877-3194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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