MEDICARE: ISBELYS COROMOTO ARENAS BRAVO

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	171M00000X	Case Manager/Care Coordinator		FL
2	104100000X	Social Worker	CBHCMS.0102636	FL

General Provider Information

NPI Number	:	1619574613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISBELYS COROMOTO ARENAS BRAVO

Provider Business Mailing Address
First Line	:	8822 W FLAGLER ST APT 9
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-2363
Country	:	US
Telephone Number	:	786-585-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	14680 SW 8TH ST STE 209
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-3138
Country	:	US
Telephone Number	:	786-585-5567
Fax Number	:

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

Provider Enumeration Date	:	10/03/2020
Last Update Date	:	03/01/2024

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