Provider Demographics
NPI:1285179846
Name:POUTOU, AMPARO
Entity Type:Individual
Prefix:
First Name:AMPARO
Middle Name:
Last Name:POUTOU
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 1:2655 W 52ND ST
Mailing Address - Street 2:UNIT 19
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2655 W 52ND ST
Practice Address - Street 2:UNIT 19
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4018
Practice Address - Country:US
Practice Address - Phone:786-223-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician