Provider Demographics
NPI:1235659863
Name:AVILA, MAGALY SOLEDAD (BAHEIVOR TECHNICIAN)
Entity Type:Individual
Prefix:MISS
First Name:MAGALY
Middle Name:SOLEDAD
Last Name:AVILA
Suffix:
Gender:F
Credentials:BAHEIVOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 W 73RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3835
Mailing Address - Country:US
Mailing Address - Phone:786-413-4504
Mailing Address - Fax:
Practice Address - Street 1:1590 W 73RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3835
Practice Address - Country:US
Practice Address - Phone:786-413-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician