1548712508 NPI number — ARIANNA ALVAREZ CRESPO BCBA

Table of content: ARIANNA ALVAREZ CRESPO BCBA (NPI 1548712508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548712508 NPI number — ARIANNA ALVAREZ CRESPO BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVAREZ CRESPO
Provider First Name:
ARIANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548712508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4475 SW 123RD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33330-1394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-506-6673
Provider Business Mailing Address Fax Number:
786-460-0264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4475 SW 123RD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33330-1394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-506-6673
Provider Business Practice Location Address Fax Number:
786-460-0264
Provider Enumeration Date:
10/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019086900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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