Provider Demographics
NPI:1396229555
Name:FALCON, ALICIA E
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:E
Last Name:FALCON
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 1:303 TIMBERLANE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8405
Mailing Address - Country:US
Mailing Address - Phone:561-255-7892
Mailing Address - Fax:
Practice Address - Street 1:303 TIMBERLANE CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-8405
Practice Address - Country:US
Practice Address - Phone:561-255-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101055100Medicaid