MEDICARE: MRS. ILEANA MARIA OXLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1104275478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILEANA MARIA OXLEY

Provider Business Mailing Address
First Line	:	16321 NW 11TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1121
Country	:	US
Telephone Number	:	954-547-9497
Fax Number	:	800-920-6493

Provider Business Practice Location Address
First Line	:	450 N PARK RD STE 400
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6918
Country	:	US
Telephone Number	:	954-547-9497
Fax Number	:	800-920-6493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/22/2023

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