MEDICARE: ILEANA SILVA PURAS

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	103K00000X	Behavior Analyst	IMH-15351	FL
2	101YM0800X	Mental Health Counselor	MH16454	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538630090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANA SILVA PURAS

Provider Business Mailing Address
First Line	:	4175 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5874
Country	:	US
Telephone Number	:	305-825-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	11852 SW 98TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-2766
Country	:	US
Telephone Number	:	305-344-6544
Fax Number	:

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/19/2018

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Directions to “ ILEANA SILVA PURAS ” Practice Location

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