Provider Demographics
NPI:1225806235
Name:PROENZA, ANA BEATRIZ
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:BEATRIZ
Last Name:PROENZA
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 1:3395 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3978
Mailing Address - Country:US
Mailing Address - Phone:786-586-6810
Mailing Address - Fax:
Practice Address - Street 1:3395 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3978
Practice Address - Country:US
Practice Address - Phone:786-586-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23310671106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician