=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861794398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILAGROS HUBERMAN MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2010
-----------------------------------------------------
Last Update Date | 12/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2999 NE 191ST ST SUITE 703
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-3123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-562-9585
-----------------------------------------------------
Fax | 305-655-2169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 601173
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-1173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-562-9585
-----------------------------------------------------
Fax | 305-655-2169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH3927
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------