Provider Demographics
NPI:1609224286
Name:ALFALLA, ARLETI
Entity Type:Individual
Prefix:
First Name:ARLETI
Middle Name:
Last Name:ALFALLA
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 1:7634 W 34TH LN UNIT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5025
Mailing Address - Country:US
Mailing Address - Phone:786-208-2907
Mailing Address - Fax:
Practice Address - Street 1:7634 W 34TH LN UNIT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-5025
Practice Address - Country:US
Practice Address - Phone:786-208-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-40479106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician