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General NPI Number Information
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NPI Number | 1841071529
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Entity Type | Organization
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Legal Business Name | EVERLASTING ACHIEVEMENTS HEALTH GROUP CORP
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 12985 SW 130TH CT STE 108-3
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City | MIAMI
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State | FL
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Zip | 33186-5312
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Country | US
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Telephone | 786-224-1234
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Fax | 305-438-6593
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Provider Business Mailing Address
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Address Line | 12985 SW 130TH CT STE 108-3
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City | MIAMI
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State | FL
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Zip | 33186-5312
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Country | US
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Telephone | 786-224-1234
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Fax | 305-438-6593
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Authorized Official
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Title or Position | CEO
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Name | MADELIN FERNANDEZ MARTELL
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Credential |
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Telephone | 786-370-5137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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