Provider Demographics
NPI:1497852099
Name:IZQUIERDO, AIDA M (PSYD)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:M
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 BISCAYNE BLVD
Mailing Address - Street 2:STE 550 A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5031
Mailing Address - Country:US
Mailing Address - Phone:305-576-4279
Mailing Address - Fax:305-318-5539
Practice Address - Street 1:2125 BISCAYNE BLVD
Practice Address - Street 2:STE 550 A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5031
Practice Address - Country:US
Practice Address - Phone:305-576-4279
Practice Address - Fax:305-318-5539
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health