Provider Demographics
NPI:1205372927
Name:DEBORA, ANIA LUISA
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:LUISA
Last Name:DEBORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 NW 135TH ST BLDG 2 APT15
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-4622
Mailing Address - Country:US
Mailing Address - Phone:305-726-1484
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:4050 NW 135TH ST BLDG 2 APT15
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-4622
Practice Address - Country:US
Practice Address - Phone:305-726-1484
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician