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NPI Code Detail

MEDICARE: DESTINY HEAVEN GALAN

MEDICARE:   DESTINY HEAVEN GALAN
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
1106S00000XBehavior TechnicianRBT-23-319549

General Provider Information

NPI Number : 1740050525
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY HEAVEN GALAN
Provider Business Mailing Address
First Line : 1501 NW 13TH CT APT 505
Second Line :
City : MIAMI
State : FL
Zip : 33125-1769
Country : US
Telephone Number : 786-620-4368
Fax Number :
Provider Business Practice Location Address
First Line : 1501 NW 13TH CT APT 505
Second Line :
City : MIAMI
State : FL
Zip : 33125-1769
Country : US
Telephone Number : 786-620-4368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2024
Last Update Date : 01/03/2024

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Directions to “ DESTINY HEAVEN GALAN ” Practice Location

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