=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942906144
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREE WINGS ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2023
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10691 N KENDALL DR STE 211
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-984-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10691 N KENDALL DR STE 211
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-984-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LORAYNE FERNANDEZ MONTIEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-984-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------